| National Provider Identifier [NPI]: | 1639330236 |
| Last Name Of The Provider | REIS |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | D.O |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 166 SPINGBROOK AVE |
| Street Address 2 Of The Provider | SUITE 105 |
| City Of The Provider | CLAYTON |
| Zip Code Of The Provider | 275202174 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 19628 |
| Number Of Medicare Beneficiaries | 834 |
| Total Submitted Charge Amount | 1892749 |
| Total Medicare Allowed Amount | 764220.94 |
| Total Medicare Payment Amount | 650621.86 |
| Total Medicare Standardized Payment Amount | 534302.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 3210 |
| Number Of Medicare Beneficiaries With Drug Services | 377 |
| Total Drug Submitted ChargeAmount | 27253 |
| Total Drug Medicare AllowedAmount | 8783.5 |
| Total Drug Medicare PaymentAmount | 6810.02 |
| Total Drug Medicare Standardized Payment Amount | 6810.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 16418 |
| Number Of Medicare Beneficiaries With Medical Services | 834 |
| Total Medical Submitted Charge Amount | 1865496 |
| Total Medical Medicare Allowed Amount | 755437.44 |
| Total Medical Medicare Payment Amount | 643811.84 |
| Total Medical Medicare Standardized Payment Amount | 527492.48 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 487 |
| Number Of Beneficiaries Age 65 to 74 | 243 |
| Number Of Beneficiaries Age 75 to 84 | 86 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 526 |
| Number Of Male Beneficiaries | 308 |
| Number Of Non Hispanic White Beneficiaries | 637 |
| Number Of Black or African American Beneficiaries | 167 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 380 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 454 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4637 |