| National Provider Identifier [NPI]: | 1093788762 |
| Last Name Of The Provider | MATLOCK |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 901 E 5TH ST |
| Street Address 2 Of The Provider | MEDICAL STAFF OFFICE |
| City Of The Provider | WASHINGTON |
| Zip Code Of The Provider | 630903127 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 870 |
| Number Of Medicare Beneficiaries | 402 |
| Total Submitted Charge Amount | 127366 |
| Total Medicare Allowed Amount | 74883.08 |
| Total Medicare Payment Amount | 57907.21 |
| Total Medicare Standardized Payment Amount | 60585.4 |
| 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 | 13 |
| Number Of Medical Services | 870 |
| Number Of Medicare Beneficiaries With Medical Services | 402 |
| Total Medical Submitted Charge Amount | 127366 |
| Total Medical Medicare Allowed Amount | 74883.08 |
| Total Medical Medicare Payment Amount | 57907.21 |
| Total Medical Medicare Standardized Payment Amount | 60585.4 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 74 |
| Number Of Beneficiaries Age 65 to 74 | 100 |
| Number Of Beneficiaries Age 75 to 84 | 121 |
| Number Of Beneficiaries Age Greater 84 | 107 |
| Number Of Female Beneficiaries | 213 |
| Number Of Male Beneficiaries | 189 |
| Number Of Non Hispanic White Beneficiaries | 385 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 277 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 125 |
| Percent Of With Atrial Fibrillation | 32 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 53 |
| Percent Of With Chronic Kidney Disease | 60 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.8677 |