| National Provider Identifier [NPI]: | 1629063169 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | TODD |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 103 N HAVEN RD |
| Street Address 2 Of The Provider | SUITE 7 |
| City Of The Provider | ELMHURST |
| Zip Code Of The Provider | 601262923 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 92 |
| Number Of Services | 6853 |
| Number Of Medicare Beneficiaries | 931 |
| Total Submitted Charge Amount | 553303.26 |
| Total Medicare Allowed Amount | 509607.35 |
| Total Medicare Payment Amount | 375686.74 |
| Total Medicare Standardized Payment Amount | 350914.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 92 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 195.52 |
| Total Drug Medicare AllowedAmount | 163.52 |
| Total Drug Medicare PaymentAmount | 124.01 |
| Total Drug Medicare Standardized Payment Amount | 124.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 91 |
| Number Of Medical Services | 6761 |
| Number Of Medicare Beneficiaries With Medical Services | 931 |
| Total Medical Submitted Charge Amount | 553107.74 |
| Total Medical Medicare Allowed Amount | 509443.83 |
| Total Medical Medicare Payment Amount | 375562.73 |
| Total Medical Medicare Standardized Payment Amount | 350790.7 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 418 |
| Number Of Beneficiaries Age 75 to 84 | 299 |
| Number Of Beneficiaries Age Greater 84 | 161 |
| Number Of Female Beneficiaries | 440 |
| Number Of Male Beneficiaries | 491 |
| Number Of Non Hispanic White Beneficiaries | 831 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 59 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 855 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 76 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0893 |