| National Provider Identifier [NPI]: | 1609833078 |
| Last Name Of The Provider | GILLEN |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6160 S YALE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741361930 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 1530 |
| Number Of Medicare Beneficiaries | 519 |
| Total Submitted Charge Amount | 138431 |
| Total Medicare Allowed Amount | 58582.27 |
| Total Medicare Payment Amount | 39715.38 |
| Total Medicare Standardized Payment Amount | 52785.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 20 |
| Number Of Drug Services | 547 |
| Number Of Medicare Beneficiaries With Drug Services | 164 |
| Total Drug Submitted ChargeAmount | 5917 |
| Total Drug Medicare AllowedAmount | 1311.81 |
| Total Drug Medicare PaymentAmount | 1012.73 |
| Total Drug Medicare Standardized Payment Amount | 1012.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 983 |
| Number Of Medicare Beneficiaries With Medical Services | 512 |
| Total Medical Submitted Charge Amount | 132514 |
| Total Medical Medicare Allowed Amount | 57270.46 |
| Total Medical Medicare Payment Amount | 38702.65 |
| Total Medical Medicare Standardized Payment Amount | 51772.87 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 89 |
| Number Of Beneficiaries Age 65 to 74 | 222 |
| Number Of Beneficiaries Age 75 to 84 | 138 |
| Number Of Beneficiaries Age Greater 84 | 70 |
| Number Of Female Beneficiaries | 280 |
| Number Of Male Beneficiaries | 239 |
| Number Of Non Hispanic White Beneficiaries | 443 |
| Number Of Black or African American Beneficiaries | 34 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 26 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 444 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0997 |