| National Provider Identifier [NPI]: | 1699753830 |
| Last Name Of The Provider | GILLIS |
| First Name Of The Provider | ALLEN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 209 W 7TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | COFFEYVILLE |
| Zip Code Of The Provider | 673374903 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 117 |
| Number Of Services | 11840 |
| Number Of Medicare Beneficiaries | 872 |
| Total Submitted Charge Amount | 631122.75 |
| Total Medicare Allowed Amount | 389504.46 |
| Total Medicare Payment Amount | 286991.26 |
| Total Medicare Standardized Payment Amount | 307510.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 910 |
| Number Of Medicare Beneficiaries With Drug Services | 525 |
| Total Drug Submitted ChargeAmount | 27715.75 |
| Total Drug Medicare AllowedAmount | 19891.38 |
| Total Drug Medicare PaymentAmount | 19197.42 |
| Total Drug Medicare Standardized Payment Amount | 19197.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 105 |
| Number Of Medical Services | 10930 |
| Number Of Medicare Beneficiaries With Medical Services | 872 |
| Total Medical Submitted Charge Amount | 603407 |
| Total Medical Medicare Allowed Amount | 369613.08 |
| Total Medical Medicare Payment Amount | 267793.84 |
| Total Medical Medicare Standardized Payment Amount | 288313.45 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 367 |
| Number Of Beneficiaries Age 75 to 84 | 267 |
| Number Of Beneficiaries Age Greater 84 | 189 |
| Number Of Female Beneficiaries | 487 |
| Number Of Male Beneficiaries | 385 |
| Number Of Non Hispanic White Beneficiaries | 814 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 25 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 798 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 74 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 2 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9542 |