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 |