| National Provider Identifier [NPI]: | 1780803098 |
| Last Name Of The Provider | BUCKTHAL-MCCUIN |
| First Name Of The Provider | JILL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 COWLES CLINC WAY |
| Street Address 2 Of The Provider | ASPEN COTTAGES |
| City Of The Provider | GREENSBORO |
| Zip Code Of The Provider | 306425285 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 7521 |
| Number Of Medicare Beneficiaries | 2037 |
| Total Submitted Charge Amount | 1351242 |
| Total Medicare Allowed Amount | 455405.54 |
| Total Medicare Payment Amount | 332694.3 |
| Total Medicare Standardized Payment Amount | 342258.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 116 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 13547 |
| Total Drug Medicare AllowedAmount | 8918.48 |
| Total Drug Medicare PaymentAmount | 6918.97 |
| Total Drug Medicare Standardized Payment Amount | 6918.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 7405 |
| Number Of Medicare Beneficiaries With Medical Services | 2037 |
| Total Medical Submitted Charge Amount | 1337695 |
| Total Medical Medicare Allowed Amount | 446487.06 |
| Total Medical Medicare Payment Amount | 325775.33 |
| Total Medical Medicare Standardized Payment Amount | 335339.38 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 96 |
| Number Of Beneficiaries Age 65 to 74 | 1077 |
| Number Of Beneficiaries Age 75 to 84 | 641 |
| Number Of Beneficiaries Age Greater 84 | 223 |
| Number Of Female Beneficiaries | 1066 |
| Number Of Male Beneficiaries | 971 |
| Number Of Non Hispanic White Beneficiaries | 1937 |
| Number Of Black or African American Beneficiaries | 50 |
| 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 | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1952 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9319 |