| National Provider Identifier [NPI]: | 1407879661 |
| Last Name Of The Provider | MCCULLOH |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1104 WALNUT DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | ARDMORE |
| Zip Code Of The Provider | 734012353 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 167 |
| Number Of Services | 17086 |
| Number Of Medicare Beneficiaries | 1359 |
| Total Submitted Charge Amount | 486864.58 |
| Total Medicare Allowed Amount | 471129.93 |
| Total Medicare Payment Amount | 359600.18 |
| Total Medicare Standardized Payment Amount | 388903.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 26 |
| Number Of Drug Services | 6757 |
| Number Of Medicare Beneficiaries With Drug Services | 573 |
| Total Drug Submitted ChargeAmount | 37661.96 |
| Total Drug Medicare AllowedAmount | 28066.1 |
| Total Drug Medicare PaymentAmount | 22557.32 |
| Total Drug Medicare Standardized Payment Amount | 22557.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 141 |
| Number Of Medical Services | 10329 |
| Number Of Medicare Beneficiaries With Medical Services | 1359 |
| Total Medical Submitted Charge Amount | 449202.62 |
| Total Medical Medicare Allowed Amount | 443063.83 |
| Total Medical Medicare Payment Amount | 337042.86 |
| Total Medical Medicare Standardized Payment Amount | 366346.18 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 192 |
| Number Of Beneficiaries Age 65 to 74 | 550 |
| Number Of Beneficiaries Age 75 to 84 | 406 |
| Number Of Beneficiaries Age Greater 84 | 211 |
| Number Of Female Beneficiaries | 813 |
| Number Of Male Beneficiaries | 546 |
| Number Of Non Hispanic White Beneficiaries | 1188 |
| Number Of Black or African American Beneficiaries | 67 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 83 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1094 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 265 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2592 |