| National Provider Identifier [NPI]: | 1710999123 |
| Last Name Of The Provider | MCCULLOUGH |
| First Name Of The Provider | HEATHER |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 333 TAMIAMI TRL S |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | VENICE |
| Zip Code Of The Provider | 342852402 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 118 |
| Number Of Services | 6481 |
| Number Of Medicare Beneficiaries | 693 |
| Total Submitted Charge Amount | 672204.4 |
| Total Medicare Allowed Amount | 272406.86 |
| Total Medicare Payment Amount | 210188.46 |
| Total Medicare Standardized Payment Amount | 211723.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 179 |
| Number Of Medicare Beneficiaries With Drug Services | 167 |
| Total Drug Submitted ChargeAmount | 15835.05 |
| Total Drug Medicare AllowedAmount | 8531.89 |
| Total Drug Medicare PaymentAmount | 8315.39 |
| Total Drug Medicare Standardized Payment Amount | 8315.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 111 |
| Number Of Medical Services | 6302 |
| Number Of Medicare Beneficiaries With Medical Services | 693 |
| Total Medical Submitted Charge Amount | 656369.35 |
| Total Medical Medicare Allowed Amount | 263874.97 |
| Total Medical Medicare Payment Amount | 201873.07 |
| Total Medical Medicare Standardized Payment Amount | 203408.6 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 283 |
| Number Of Beneficiaries Age 75 to 84 | 231 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 612 |
| Number Of Male Beneficiaries | 81 |
| Number Of Non Hispanic White Beneficiaries | 677 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.8667 |