| National Provider Identifier [NPI]: | 1922105220 |
| Last Name Of The Provider | HAYCRAFT |
| First Name Of The Provider | GORDON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1723 BROADWAY |
| Street Address 2 Of The Provider | SUITE 310 |
| City Of The Provider | CAPE GIRARDEAU |
| Zip Code Of The Provider | 63701 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 3452 |
| Number Of Medicare Beneficiaries | 2489 |
| Total Submitted Charge Amount | 108800 |
| Total Medicare Allowed Amount | 38462.06 |
| Total Medicare Payment Amount | 29185.74 |
| Total Medicare Standardized Payment Amount | 28851.35 |
| 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 | 15 |
| Number Of Medical Services | 3452 |
| Number Of Medicare Beneficiaries With Medical Services | 2489 |
| Total Medical Submitted Charge Amount | 108800 |
| Total Medical Medicare Allowed Amount | 38462.06 |
| Total Medical Medicare Payment Amount | 29185.74 |
| Total Medical Medicare Standardized Payment Amount | 28851.35 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 542 |
| Number Of Beneficiaries Age 65 to 74 | 815 |
| Number Of Beneficiaries Age 75 to 84 | 727 |
| Number Of Beneficiaries Age Greater 84 | 405 |
| Number Of Female Beneficiaries | 1384 |
| Number Of Male Beneficiaries | 1105 |
| Number Of Non Hispanic White Beneficiaries | 2303 |
| Number Of Black or African American Beneficiaries | 160 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1665 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 824 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.67 |