| National Provider Identifier [NPI]: | 1073581849 |
| Last Name Of The Provider | CO |
| First Name Of The Provider | HENRY |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 HOSPITAL DR STE 101 |
| Street Address 2 Of The Provider | CCOM MEDICAL GROUP, INC. |
| City Of The Provider | EUFAULA |
| Zip Code Of The Provider | 744324010 |
| 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 | 130 |
| Number Of Services | 8767 |
| Number Of Medicare Beneficiaries | 1701 |
| Total Submitted Charge Amount | 1283769.71 |
| Total Medicare Allowed Amount | 502827.78 |
| Total Medicare Payment Amount | 360226.71 |
| Total Medicare Standardized Payment Amount | 386629.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 18 |
| Number Of Drug Services | 347 |
| Number Of Medicare Beneficiaries With Drug Services | 196 |
| Total Drug Submitted ChargeAmount | 18326 |
| Total Drug Medicare AllowedAmount | 3297.84 |
| Total Drug Medicare PaymentAmount | 3123.71 |
| Total Drug Medicare Standardized Payment Amount | 3123.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 112 |
| Number Of Medical Services | 8420 |
| Number Of Medicare Beneficiaries With Medical Services | 1701 |
| Total Medical Submitted Charge Amount | 1265443.71 |
| Total Medical Medicare Allowed Amount | 499529.94 |
| Total Medical Medicare Payment Amount | 357103 |
| Total Medical Medicare Standardized Payment Amount | 383505.62 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 436 |
| Number Of Beneficiaries Age 65 to 74 | 602 |
| Number Of Beneficiaries Age 75 to 84 | 449 |
| Number Of Beneficiaries Age Greater 84 | 214 |
| Number Of Female Beneficiaries | 1033 |
| Number Of Male Beneficiaries | 668 |
| Number Of Non Hispanic White Beneficiaries | 1361 |
| Number Of Black or African American Beneficiaries | 120 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | 186 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1019 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 682 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4573 |