| National Provider Identifier [NPI]: | 1760550602 |
| Last Name Of The Provider | GILLIAM |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 LAUCHWOOD DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAURINBURG |
| Zip Code Of The Provider | 283525501 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 1159 |
| Number Of Medicare Beneficiaries | 555 |
| Total Submitted Charge Amount | 283952 |
| Total Medicare Allowed Amount | 130220.03 |
| Total Medicare Payment Amount | 99428.55 |
| Total Medicare Standardized Payment Amount | 103896.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 1159 |
| Number Of Medicare Beneficiaries With Medical Services | 555 |
| Total Medical Submitted Charge Amount | 283952 |
| Total Medical Medicare Allowed Amount | 130220.03 |
| Total Medical Medicare Payment Amount | 99428.55 |
| Total Medical Medicare Standardized Payment Amount | 103896.62 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 164 |
| Number Of Beneficiaries Age 65 to 74 | 180 |
| Number Of Beneficiaries Age 75 to 84 | 128 |
| Number Of Beneficiaries Age Greater 84 | 83 |
| Number Of Female Beneficiaries | 326 |
| Number Of Male Beneficiaries | 229 |
| Number Of Non Hispanic White Beneficiaries | 266 |
| Number Of Black or African American Beneficiaries | 183 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 71 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 235 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 320 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 59 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 55 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.6702 |