| National Provider Identifier [NPI]: | 1184612095 |
| Last Name Of The Provider | GILLESPIE |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 94 MEDICAL CIR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOULTON |
| Zip Code Of The Provider | 356501256 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 130 |
| Number Of Services | 11133 |
| Number Of Medicare Beneficiaries | 565 |
| Total Submitted Charge Amount | 680016 |
| Total Medicare Allowed Amount | 451835.75 |
| Total Medicare Payment Amount | 316491.12 |
| Total Medicare Standardized Payment Amount | 349089.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 1288 |
| Number Of Medicare Beneficiaries With Drug Services | 284 |
| Total Drug Submitted ChargeAmount | 12969 |
| Total Drug Medicare AllowedAmount | 2730.06 |
| Total Drug Medicare PaymentAmount | 2231.52 |
| Total Drug Medicare Standardized Payment Amount | 2231.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 116 |
| Number Of Medical Services | 9845 |
| Number Of Medicare Beneficiaries With Medical Services | 563 |
| Total Medical Submitted Charge Amount | 667047 |
| Total Medical Medicare Allowed Amount | 449105.69 |
| Total Medical Medicare Payment Amount | 314259.6 |
| Total Medical Medicare Standardized Payment Amount | 346858.06 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 102 |
| Number Of Beneficiaries Age 65 to 74 | 245 |
| Number Of Beneficiaries Age 75 to 84 | 169 |
| Number Of Beneficiaries Age Greater 84 | 49 |
| Number Of Female Beneficiaries | 293 |
| Number Of Male Beneficiaries | 272 |
| Number Of Non Hispanic White Beneficiaries | 533 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 446 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 119 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.4065 |