| National Provider Identifier [NPI]: | 1497747273 |
| Last Name Of The Provider | WILLIAMS |
| First Name Of The Provider | TED |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 703 S FLEISHEL AVE STE 4000 |
| Street Address 2 Of The Provider | |
| City Of The Provider | TYLER |
| Zip Code Of The Provider | 757012015 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 263 |
| Number Of Medicare Beneficiaries | 217 |
| Total Submitted Charge Amount | 62536 |
| Total Medicare Allowed Amount | 28019.46 |
| Total Medicare Payment Amount | 21959.66 |
| Total Medicare Standardized Payment Amount | 26800.91 |
| 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 | 10 |
| Number Of Medical Services | 263 |
| Number Of Medicare Beneficiaries With Medical Services | 217 |
| Total Medical Submitted Charge Amount | 62536 |
| Total Medical Medicare Allowed Amount | 28019.46 |
| Total Medical Medicare Payment Amount | 21959.66 |
| Total Medical Medicare Standardized Payment Amount | 26800.91 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 79 |
| Number Of Beneficiaries Age 75 to 84 | 73 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 100 |
| Number Of Non Hispanic White Beneficiaries | 176 |
| Number Of Black or African American Beneficiaries | 28 |
| 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 | 176 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 39 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 54 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.7139 |