| National Provider Identifier [NPI]: | 1003883885 |
| Last Name Of The Provider | DAVANI |
| First Name Of The Provider | MANDANA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 HEALTH PARK BLVD |
| Street Address 2 Of The Provider | ATTN: RADIOLOGY DEPARTMENT |
| City Of The Provider | SAINT AUGUSTINE |
| Zip Code Of The Provider | 320865784 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 155 |
| Number Of Services | 6615 |
| Number Of Medicare Beneficiaries | 3767 |
| Total Submitted Charge Amount | 755117 |
| Total Medicare Allowed Amount | 243592.28 |
| Total Medicare Payment Amount | 187771.44 |
| Total Medicare Standardized Payment Amount | 189273.76 |
| 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 | 155 |
| Number Of Medical Services | 6615 |
| Number Of Medicare Beneficiaries With Medical Services | 3767 |
| Total Medical Submitted Charge Amount | 755117 |
| Total Medical Medicare Allowed Amount | 243592.28 |
| Total Medical Medicare Payment Amount | 187771.44 |
| Total Medical Medicare Standardized Payment Amount | 189273.76 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 518 |
| Number Of Beneficiaries Age 65 to 74 | 1435 |
| Number Of Beneficiaries Age 75 to 84 | 1192 |
| Number Of Beneficiaries Age Greater 84 | 622 |
| Number Of Female Beneficiaries | 2292 |
| Number Of Male Beneficiaries | 1475 |
| Number Of Non Hispanic White Beneficiaries | 3316 |
| Number Of Black or African American Beneficiaries | 296 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 91 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2996 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 771 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.5746 |