| National Provider Identifier [NPI]: | 1902836398 |
| Last Name Of The Provider | TILLMAN |
| First Name Of The Provider | BRYAN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 MEDICAL CENTER BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WINSTON-SALEM |
| Zip Code Of The Provider | 271570001 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Vascular Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 94 |
| Number Of Services | 863 |
| Number Of Medicare Beneficiaries | 565 |
| Total Submitted Charge Amount | 353638 |
| Total Medicare Allowed Amount | 92479.08 |
| Total Medicare Payment Amount | 70934.42 |
| Total Medicare Standardized Payment Amount | 73786.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 94 |
| Number Of Medical Services | 863 |
| Number Of Medicare Beneficiaries With Medical Services | 565 |
| Total Medical Submitted Charge Amount | 353638 |
| Total Medical Medicare Allowed Amount | 92479.08 |
| Total Medical Medicare Payment Amount | 70934.42 |
| Total Medical Medicare Standardized Payment Amount | 73786.78 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 120 |
| Number Of Beneficiaries Age 65 to 74 | 191 |
| Number Of Beneficiaries Age 75 to 84 | 165 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 284 |
| Number Of Male Beneficiaries | 281 |
| Number Of Non Hispanic White Beneficiaries | 429 |
| 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 | 403 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 162 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 67 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.9055 |