| National Provider Identifier [NPI]: | 1730109414 |
| Last Name Of The Provider | WATERS |
| First Name Of The Provider | GORDON |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 120 E CARTER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BLACKSHEAR |
| Zip Code Of The Provider | 315161561 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 144 |
| Number Of Services | 5300 |
| Number Of Medicare Beneficiaries | 886 |
| Total Submitted Charge Amount | 383780.01 |
| Total Medicare Allowed Amount | 241099.09 |
| Total Medicare Payment Amount | 170962.06 |
| Total Medicare Standardized Payment Amount | 180360.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 989 |
| Number Of Medicare Beneficiaries With Drug Services | 155 |
| Total Drug Submitted ChargeAmount | 16095.01 |
| Total Drug Medicare AllowedAmount | 10249.58 |
| Total Drug Medicare PaymentAmount | 8101.88 |
| Total Drug Medicare Standardized Payment Amount | 8101.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 128 |
| Number Of Medical Services | 4311 |
| Number Of Medicare Beneficiaries With Medical Services | 885 |
| Total Medical Submitted Charge Amount | 367685 |
| Total Medical Medicare Allowed Amount | 230849.51 |
| Total Medical Medicare Payment Amount | 162860.18 |
| Total Medical Medicare Standardized Payment Amount | 172258.58 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 233 |
| Number Of Beneficiaries Age 65 to 74 | 325 |
| Number Of Beneficiaries Age 75 to 84 | 205 |
| Number Of Beneficiaries Age Greater 84 | 123 |
| Number Of Female Beneficiaries | 497 |
| Number Of Male Beneficiaries | 389 |
| Number Of Non Hispanic White Beneficiaries | 792 |
| Number Of Black or African American Beneficiaries | 81 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 544 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 342 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3323 |