| National Provider Identifier [NPI]: | 1912907056 |
| Last Name Of The Provider | HYDE |
| First Name Of The Provider | GLEN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1608 PROFESSIONAL CIR |
| Street Address 2 Of The Provider | |
| City Of The Provider | YUKON |
| Zip Code Of The Provider | 730996314 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 2136 |
| Number Of Medicare Beneficiaries | 395 |
| Total Submitted Charge Amount | 273437 |
| Total Medicare Allowed Amount | 142310.21 |
| Total Medicare Payment Amount | 96585.37 |
| Total Medicare Standardized Payment Amount | 106623.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 113 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 1924 |
| Total Drug Medicare AllowedAmount | 709.02 |
| Total Drug Medicare PaymentAmount | 630.66 |
| Total Drug Medicare Standardized Payment Amount | 630.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 2023 |
| Number Of Medicare Beneficiaries With Medical Services | 395 |
| Total Medical Submitted Charge Amount | 271513 |
| Total Medical Medicare Allowed Amount | 141601.19 |
| Total Medical Medicare Payment Amount | 95954.71 |
| Total Medical Medicare Standardized Payment Amount | 105993.09 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 197 |
| Number Of Beneficiaries Age 75 to 84 | 119 |
| Number Of Beneficiaries Age Greater 84 | 45 |
| Number Of Female Beneficiaries | 219 |
| Number Of Male Beneficiaries | 176 |
| Number Of Non Hispanic White Beneficiaries | 368 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 350 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 45 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1373 |