| National Provider Identifier [NPI]: | 1366641243 |
| Last Name Of The Provider | MCCULLOUGH |
| First Name Of The Provider | HEATH |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | N CAROLINA BAPTIST HOSPITAL |
| Street Address 2 Of The Provider | MEDICAL CENTER BLVD |
| City Of The Provider | WINSTON SALEM |
| Zip Code Of The Provider | 271570001 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 222 |
| Number Of Services | 6320 |
| Number Of Medicare Beneficiaries | 2236 |
| Total Submitted Charge Amount | 522019.98 |
| Total Medicare Allowed Amount | 154261.42 |
| Total Medicare Payment Amount | 116456.6 |
| Total Medicare Standardized Payment Amount | 123560.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2978 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 876.98 |
| Total Drug Medicare AllowedAmount | 567.27 |
| Total Drug Medicare PaymentAmount | 400.83 |
| Total Drug Medicare Standardized Payment Amount | 400.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 220 |
| Number Of Medical Services | 3342 |
| Number Of Medicare Beneficiaries With Medical Services | 2236 |
| Total Medical Submitted Charge Amount | 521143 |
| Total Medical Medicare Allowed Amount | 153694.15 |
| Total Medical Medicare Payment Amount | 116055.77 |
| Total Medical Medicare Standardized Payment Amount | 123159.71 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 562 |
| Number Of Beneficiaries Age 65 to 74 | 675 |
| Number Of Beneficiaries Age 75 to 84 | 659 |
| Number Of Beneficiaries Age Greater 84 | 340 |
| Number Of Female Beneficiaries | 1269 |
| Number Of Male Beneficiaries | 967 |
| Number Of Non Hispanic White Beneficiaries | 1641 |
| Number Of Black or African American Beneficiaries | 524 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1500 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 736 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.1366 |