| National Provider Identifier [NPI]: | 1972530954 |
| Last Name Of The Provider | MCCOLLOUGH |
| First Name Of The Provider | MARTHA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1367 DOMINION PLAZA |
| Street Address 2 Of The Provider | |
| City Of The Provider | TYLER |
| Zip Code Of The Provider | 757031013 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 19564 |
| Number Of Medicare Beneficiaries | 6163 |
| Total Submitted Charge Amount | 2780609.61 |
| Total Medicare Allowed Amount | 1064279.2 |
| Total Medicare Payment Amount | 791851.71 |
| Total Medicare Standardized Payment Amount | 729867.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 862 |
| Number Of Medicare Beneficiaries With Drug Services | 93 |
| Total Drug Submitted ChargeAmount | 16956.2 |
| Total Drug Medicare AllowedAmount | 9081.75 |
| Total Drug Medicare PaymentAmount | 7010.91 |
| Total Drug Medicare Standardized Payment Amount | 7010.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 70 |
| Number Of Medical Services | 18702 |
| Number Of Medicare Beneficiaries With Medical Services | 6163 |
| Total Medical Submitted Charge Amount | 2763653.41 |
| Total Medical Medicare Allowed Amount | 1055197.45 |
| Total Medical Medicare Payment Amount | 784840.8 |
| Total Medical Medicare Standardized Payment Amount | 722856.4 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 249 |
| Number Of Beneficiaries Age 65 to 74 | 2601 |
| Number Of Beneficiaries Age 75 to 84 | 2388 |
| Number Of Beneficiaries Age Greater 84 | 925 |
| Number Of Female Beneficiaries | 3058 |
| Number Of Male Beneficiaries | 3105 |
| Number Of Non Hispanic White Beneficiaries | 6022 |
| Number Of Black or African American Beneficiaries | 53 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 47 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 5787 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 376 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0605 |