National Provider Identifier [NPI]: |
1073591426 |
Last Name Of The Provider |
GIBBONS |
First Name Of The Provider |
PAUL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4465 DARROW RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
STOW |
Zip Code Of The Provider |
442241854 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
52 |
Number Of Services |
1480 |
Number Of Medicare Beneficiaries |
312 |
Total Submitted Charge Amount |
179185 |
Total Medicare Allowed Amount |
94771.69 |
Total Medicare Payment Amount |
68700.9 |
Total Medicare Standardized Payment Amount |
71215.32 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
108 |
Number Of Medicare Beneficiaries With Drug Services |
79 |
Total Drug Submitted ChargeAmount |
11299 |
Total Drug Medicare AllowedAmount |
6192.9 |
Total Drug Medicare PaymentAmount |
6052.16 |
Total Drug Medicare Standardized Payment Amount |
6052.16 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
43 |
Number Of Medical Services |
1372 |
Number Of Medicare Beneficiaries With Medical Services |
312 |
Total Medical Submitted Charge Amount |
167886 |
Total Medical Medicare Allowed Amount |
88578.79 |
Total Medical Medicare Payment Amount |
62648.74 |
Total Medical Medicare Standardized Payment Amount |
65163.16 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
37 |
Number Of Beneficiaries Age 65 to 74 |
98 |
Number Of Beneficiaries Age 75 to 84 |
97 |
Number Of Beneficiaries Age Greater 84 |
80 |
Number Of Female Beneficiaries |
186 |
Number Of Male Beneficiaries |
126 |
Number Of Non Hispanic White Beneficiaries |
299 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
269 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
43 |
Percent Of With Atrial Fibrillation |
16 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
67 |
Percent Of With Ischemic Heart Disease |
36 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
41 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.3306 |