| National Provider Identifier [NPI]: | 1497774384 |
| Last Name Of The Provider | TILLMAN |
| First Name Of The Provider | JAY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 50 ALBANY TURNPIKE |
| Street Address 2 Of The Provider | CANTON GATEWAY OFFICE PARK #16 |
| City Of The Provider | CANTON |
| Zip Code Of The Provider | 06019 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 2199 |
| Number Of Medicare Beneficiaries | 815 |
| Total Submitted Charge Amount | 236985 |
| Total Medicare Allowed Amount | 232591.89 |
| Total Medicare Payment Amount | 181108.08 |
| Total Medicare Standardized Payment Amount | 172152.16 |
| 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 | 9 |
| Number Of Medical Services | 2199 |
| Number Of Medicare Beneficiaries With Medical Services | 815 |
| Total Medical Submitted Charge Amount | 236985 |
| Total Medical Medicare Allowed Amount | 232591.89 |
| Total Medical Medicare Payment Amount | 181108.08 |
| Total Medical Medicare Standardized Payment Amount | 172152.16 |
| Average Age Of Beneficiaries | 82 |
| Number Of Beneficiaries Age Less65 | 65 |
| Number Of Beneficiaries Age 65 to 74 | 115 |
| Number Of Beneficiaries Age 75 to 84 | 246 |
| Number Of Beneficiaries Age Greater 84 | 389 |
| Number Of Female Beneficiaries | 530 |
| Number Of Male Beneficiaries | 285 |
| Number Of Non Hispanic White Beneficiaries | 631 |
| Number Of Black or African American Beneficiaries | 128 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 43 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 202 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 613 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 25 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 2.3352 |