| National Provider Identifier [NPI]: | 1497861702 |
| Last Name Of The Provider | DETERS |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 RICHMOND AVE E |
| Street Address 2 Of The Provider | |
| City Of The Provider | MATTOON |
| Zip Code Of The Provider | 619384652 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 4839 |
| Number Of Medicare Beneficiaries | 534 |
| Total Submitted Charge Amount | 299576 |
| Total Medicare Allowed Amount | 204375.88 |
| Total Medicare Payment Amount | 140342.09 |
| Total Medicare Standardized Payment Amount | 146407.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 20 |
| Number Of Drug Services | 1316 |
| Number Of Medicare Beneficiaries With Drug Services | 211 |
| Total Drug Submitted ChargeAmount | 27873 |
| Total Drug Medicare AllowedAmount | 11567.22 |
| Total Drug Medicare PaymentAmount | 9775.53 |
| Total Drug Medicare Standardized Payment Amount | 9775.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 3523 |
| Number Of Medicare Beneficiaries With Medical Services | 534 |
| Total Medical Submitted Charge Amount | 271703 |
| Total Medical Medicare Allowed Amount | 192808.66 |
| Total Medical Medicare Payment Amount | 130566.56 |
| Total Medical Medicare Standardized Payment Amount | 136631.65 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 213 |
| Number Of Beneficiaries Age 75 to 84 | 129 |
| Number Of Beneficiaries Age Greater 84 | 135 |
| Number Of Female Beneficiaries | 312 |
| Number Of Male Beneficiaries | 222 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 412 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 122 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.32 |