| National Provider Identifier [NPI]: | 1932103629 |
| Last Name Of The Provider | WILLIAMS |
| First Name Of The Provider | BALMORE |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 309 E CROCKETT ST |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | CLEVELAND |
| Zip Code Of The Provider | 773273810 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 507 |
| Number Of Medicare Beneficiaries | 113 |
| Total Submitted Charge Amount | 46391 |
| Total Medicare Allowed Amount | 19735.81 |
| Total Medicare Payment Amount | 12129.79 |
| Total Medicare Standardized Payment Amount | 13754.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 120 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 2865 |
| Total Drug Medicare AllowedAmount | 415.77 |
| Total Drug Medicare PaymentAmount | 398.74 |
| Total Drug Medicare Standardized Payment Amount | 398.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 387 |
| Number Of Medicare Beneficiaries With Medical Services | 113 |
| Total Medical Submitted Charge Amount | 43526 |
| Total Medical Medicare Allowed Amount | 19320.04 |
| Total Medical Medicare Payment Amount | 11731.05 |
| Total Medical Medicare Standardized Payment Amount | 13356 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 47 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 61 |
| Number Of Male Beneficiaries | 52 |
| Number Of Non Hispanic White Beneficiaries | 93 |
| 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 | 62 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4453 |