| National Provider Identifier [NPI]: | 1053309229 |
| Last Name Of The Provider | GILLOCK |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 70 MEDICAL CENTER CIR |
| Street Address 2 Of The Provider | SUITE 208 |
| City Of The Provider | FISHERSVILLE |
| Zip Code Of The Provider | 229392273 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 99 |
| Number Of Services | 8439 |
| Number Of Medicare Beneficiaries | 1439 |
| Total Submitted Charge Amount | 1400922.6 |
| Total Medicare Allowed Amount | 556579.46 |
| Total Medicare Payment Amount | 413810.27 |
| Total Medicare Standardized Payment Amount | 422910.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 2279 |
| Number Of Medicare Beneficiaries With Drug Services | 89 |
| Total Drug Submitted ChargeAmount | 364477.6 |
| Total Drug Medicare AllowedAmount | 119058.39 |
| Total Drug Medicare PaymentAmount | 92349.1 |
| Total Drug Medicare Standardized Payment Amount | 92349.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 91 |
| Number Of Medical Services | 6160 |
| Number Of Medicare Beneficiaries With Medical Services | 1439 |
| Total Medical Submitted Charge Amount | 1036445 |
| Total Medical Medicare Allowed Amount | 437521.07 |
| Total Medical Medicare Payment Amount | 321461.17 |
| Total Medical Medicare Standardized Payment Amount | 330561.88 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 82 |
| Number Of Beneficiaries Age 65 to 74 | 552 |
| Number Of Beneficiaries Age 75 to 84 | 583 |
| Number Of Beneficiaries Age Greater 84 | 222 |
| Number Of Female Beneficiaries | 425 |
| Number Of Male Beneficiaries | 1014 |
| Number Of Non Hispanic White Beneficiaries | 1357 |
| Number Of Black or African American Beneficiaries | 53 |
| 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 | 1340 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 99 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 28 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0992 |