| National Provider Identifier [NPI]: | 1700874914 |
| Last Name Of The Provider | FAIRLIE |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13420 N PENNSYLVANIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 731209007 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 564 |
| Number Of Medicare Beneficiaries | 270 |
| Total Submitted Charge Amount | 46840.11 |
| Total Medicare Allowed Amount | 29647.75 |
| Total Medicare Payment Amount | 21394.11 |
| Total Medicare Standardized Payment Amount | 24131.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 57 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 472.93 |
| Total Drug Medicare AllowedAmount | 161.82 |
| Total Drug Medicare PaymentAmount | 122.92 |
| Total Drug Medicare Standardized Payment Amount | 122.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 507 |
| Number Of Medicare Beneficiaries With Medical Services | 270 |
| Total Medical Submitted Charge Amount | 46367.18 |
| Total Medical Medicare Allowed Amount | 29485.93 |
| Total Medical Medicare Payment Amount | 21271.19 |
| Total Medical Medicare Standardized Payment Amount | 24008.15 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 135 |
| Number Of Beneficiaries Age 75 to 84 | 61 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 178 |
| Number Of Male Beneficiaries | 92 |
| Number Of Non Hispanic White Beneficiaries | 239 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 229 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.968 |