| National Provider Identifier [NPI]: | 1194708552 |
| Last Name Of The Provider | GUSTAFSON |
| First Name Of The Provider | CYNTHIA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1050 SE MONTEREY RD |
| Street Address 2 Of The Provider | SUITE 102 |
| City Of The Provider | STUART |
| Zip Code Of The Provider | 349944512 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 3609 |
| Number Of Medicare Beneficiaries | 883 |
| Total Submitted Charge Amount | 1244129.46 |
| Total Medicare Allowed Amount | 331455.18 |
| Total Medicare Payment Amount | 245130.82 |
| Total Medicare Standardized Payment Amount | 235209.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 692 |
| Number Of Medicare Beneficiaries With Drug Services | 201 |
| Total Drug Submitted ChargeAmount | 30394.9 |
| Total Drug Medicare AllowedAmount | 3299.28 |
| Total Drug Medicare PaymentAmount | 2459.71 |
| Total Drug Medicare Standardized Payment Amount | 2459.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 58 |
| Number Of Medical Services | 2917 |
| Number Of Medicare Beneficiaries With Medical Services | 883 |
| Total Medical Submitted Charge Amount | 1213734.56 |
| Total Medical Medicare Allowed Amount | 328155.9 |
| Total Medical Medicare Payment Amount | 242671.11 |
| Total Medical Medicare Standardized Payment Amount | 232750.1 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 386 |
| Number Of Beneficiaries Age 75 to 84 | 331 |
| Number Of Beneficiaries Age Greater 84 | 114 |
| Number Of Female Beneficiaries | 575 |
| Number Of Male Beneficiaries | 308 |
| Number Of Non Hispanic White Beneficiaries | 826 |
| Number Of Black or African American Beneficiaries | 17 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 851 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 25 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1242 |