| National Provider Identifier [NPI]: | 1598761892 |
| Last Name Of The Provider | GRANT |
| First Name Of The Provider | TERRY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2700 WAYNE MEMORIAL DR |
| Street Address 2 Of The Provider | EMERGENCY DEPT |
| City Of The Provider | GOLDSBORO |
| Zip Code Of The Provider | 275349494 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 2418 |
| Number Of Medicare Beneficiaries | 1202 |
| Total Submitted Charge Amount | 503775 |
| Total Medicare Allowed Amount | 202094.64 |
| Total Medicare Payment Amount | 152415.44 |
| Total Medicare Standardized Payment Amount | 158199.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 174 |
| Number Of Medicare Beneficiaries With Drug Services | 88 |
| Total Drug Submitted ChargeAmount | 3247 |
| Total Drug Medicare AllowedAmount | 1051.9 |
| Total Drug Medicare PaymentAmount | 966.42 |
| Total Drug Medicare Standardized Payment Amount | 966.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 92 |
| Number Of Medical Services | 2244 |
| Number Of Medicare Beneficiaries With Medical Services | 1202 |
| Total Medical Submitted Charge Amount | 500528 |
| Total Medical Medicare Allowed Amount | 201042.74 |
| Total Medical Medicare Payment Amount | 151449.02 |
| Total Medical Medicare Standardized Payment Amount | 157232.77 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 346 |
| Number Of Beneficiaries Age 65 to 74 | 359 |
| Number Of Beneficiaries Age 75 to 84 | 334 |
| Number Of Beneficiaries Age Greater 84 | 163 |
| Number Of Female Beneficiaries | 700 |
| Number Of Male Beneficiaries | 502 |
| Number Of Non Hispanic White Beneficiaries | 796 |
| Number Of Black or African American Beneficiaries | 371 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 723 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 479 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.689 |