| National Provider Identifier [NPI]: | 1447297296 |
| Last Name Of The Provider | HOLLIMAN |
| First Name Of The Provider | BRENT |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4345 W MEMORIAL RD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 731341702 |
| 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 | 45 |
| Number Of Services | 249 |
| Number Of Medicare Beneficiaries | 69 |
| Total Submitted Charge Amount | 22107 |
| Total Medicare Allowed Amount | 9000.48 |
| Total Medicare Payment Amount | 7067.26 |
| Total Medicare Standardized Payment Amount | 8835.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 58 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 348 |
| Total Drug Medicare AllowedAmount | 107.91 |
| Total Drug Medicare PaymentAmount | 84.63 |
| Total Drug Medicare Standardized Payment Amount | 84.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 191 |
| Number Of Medicare Beneficiaries With Medical Services | 69 |
| Total Medical Submitted Charge Amount | 21759 |
| Total Medical Medicare Allowed Amount | 8892.57 |
| Total Medical Medicare Payment Amount | 6982.63 |
| Total Medical Medicare Standardized Payment Amount | 8750.61 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 37 |
| Number Of Beneficiaries Age 75 to 84 | 15 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 53 |
| Number Of Male Beneficiaries | 16 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0059 |