| National Provider Identifier [NPI]: | 1013936749 |
| Last Name Of The Provider | GUILLIAMS |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1965 S FREMONT AVE |
| Street Address 2 Of The Provider | SUITE 370 |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 658042201 |
| 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 | 82 |
| Number Of Services | 2048 |
| Number Of Medicare Beneficiaries | 629 |
| Total Submitted Charge Amount | 734099.9 |
| Total Medicare Allowed Amount | 197656.04 |
| Total Medicare Payment Amount | 148329.02 |
| Total Medicare Standardized Payment Amount | 157545.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 184 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 148025 |
| Total Drug Medicare AllowedAmount | 23755.1 |
| Total Drug Medicare PaymentAmount | 18340.88 |
| Total Drug Medicare Standardized Payment Amount | 18340.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 1864 |
| Number Of Medicare Beneficiaries With Medical Services | 629 |
| Total Medical Submitted Charge Amount | 586074.9 |
| Total Medical Medicare Allowed Amount | 173900.94 |
| Total Medical Medicare Payment Amount | 129988.14 |
| Total Medical Medicare Standardized Payment Amount | 139204.75 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 75 |
| Number Of Beneficiaries Age 65 to 74 | 288 |
| Number Of Beneficiaries Age 75 to 84 | 197 |
| Number Of Beneficiaries Age Greater 84 | 69 |
| Number Of Female Beneficiaries | 139 |
| Number Of Male Beneficiaries | 490 |
| Number Of Non Hispanic White Beneficiaries | 597 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 537 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 92 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 30 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3019 |