| National Provider Identifier [NPI]: | 1396702965 |
| Last Name Of The Provider | PHILLIPS |
| First Name Of The Provider | DERRICK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3051 WATSON BLVD |
| Street Address 2 Of The Provider | SUITE 525 |
| City Of The Provider | WARNER ROBINS |
| Zip Code Of The Provider | 310938536 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 167 |
| Number Of Services | 3388 |
| Number Of Medicare Beneficiaries | 516 |
| Total Submitted Charge Amount | 1122921 |
| Total Medicare Allowed Amount | 276646.95 |
| Total Medicare Payment Amount | 203982.27 |
| Total Medicare Standardized Payment Amount | 218728.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 781 |
| Number Of Medicare Beneficiaries With Drug Services | 287 |
| Total Drug Submitted ChargeAmount | 85576 |
| Total Drug Medicare AllowedAmount | 23894.09 |
| Total Drug Medicare PaymentAmount | 17928.36 |
| Total Drug Medicare Standardized Payment Amount | 17928.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 163 |
| Number Of Medical Services | 2607 |
| Number Of Medicare Beneficiaries With Medical Services | 516 |
| Total Medical Submitted Charge Amount | 1037345 |
| Total Medical Medicare Allowed Amount | 252752.86 |
| Total Medical Medicare Payment Amount | 186053.91 |
| Total Medical Medicare Standardized Payment Amount | 200799.73 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 134 |
| Number Of Beneficiaries Age 65 to 74 | 225 |
| Number Of Beneficiaries Age 75 to 84 | 120 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 352 |
| Number Of Male Beneficiaries | 164 |
| Number Of Non Hispanic White Beneficiaries | 267 |
| Number Of Black or African American Beneficiaries | |
| 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 | 400 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 116 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 65 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3733 |