| National Provider Identifier [NPI]: | 1710977566 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD PHD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5901 TECHNOLOGY CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462786013 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 207 |
| Number Of Services | 5813 |
| Number Of Medicare Beneficiaries | 3641 |
| Total Submitted Charge Amount | 475710 |
| Total Medicare Allowed Amount | 157550.12 |
| Total Medicare Payment Amount | 125380.12 |
| Total Medicare Standardized Payment Amount | 132174.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 207 |
| Number Of Medical Services | 5813 |
| Number Of Medicare Beneficiaries With Medical Services | 3641 |
| Total Medical Submitted Charge Amount | 475710 |
| Total Medical Medicare Allowed Amount | 157550.12 |
| Total Medical Medicare Payment Amount | 125380.12 |
| Total Medical Medicare Standardized Payment Amount | 132174.7 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 717 |
| Number Of Beneficiaries Age 65 to 74 | 1234 |
| Number Of Beneficiaries Age 75 to 84 | 1082 |
| Number Of Beneficiaries Age Greater 84 | 608 |
| Number Of Female Beneficiaries | 2327 |
| Number Of Male Beneficiaries | 1314 |
| Number Of Non Hispanic White Beneficiaries | 3264 |
| Number Of Black or African American Beneficiaries | 313 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2674 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 967 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7886 |