| National Provider Identifier [NPI]: | 1699810507 |
| Last Name Of The Provider | BULLOCK |
| First Name Of The Provider | TRAVIS |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12855 N. FORTY DR. |
| Street Address 2 Of The Provider | STE 375 |
| City Of The Provider | ST. LOUIS |
| Zip Code Of The Provider | 63141 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 101 |
| Number Of Services | 12375 |
| Number Of Medicare Beneficiaries | 897 |
| Total Submitted Charge Amount | 1037376.25 |
| Total Medicare Allowed Amount | 498384.71 |
| Total Medicare Payment Amount | 373208.03 |
| Total Medicare Standardized Payment Amount | 380791.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 7657 |
| Number Of Medicare Beneficiaries With Drug Services | 61 |
| Total Drug Submitted ChargeAmount | 49953.75 |
| Total Drug Medicare AllowedAmount | 39005.39 |
| Total Drug Medicare PaymentAmount | 30039.9 |
| Total Drug Medicare Standardized Payment Amount | 30039.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 4718 |
| Number Of Medicare Beneficiaries With Medical Services | 897 |
| Total Medical Submitted Charge Amount | 987422.5 |
| Total Medical Medicare Allowed Amount | 459379.32 |
| Total Medical Medicare Payment Amount | 343168.13 |
| Total Medical Medicare Standardized Payment Amount | 350752.02 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 366 |
| Number Of Beneficiaries Age 75 to 84 | 290 |
| Number Of Beneficiaries Age Greater 84 | 142 |
| Number Of Female Beneficiaries | 699 |
| Number Of Male Beneficiaries | 198 |
| Number Of Non Hispanic White Beneficiaries | 845 |
| Number Of Black or African American Beneficiaries | 37 |
| 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 | 812 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2433 |