| National Provider Identifier [NPI]: | 1902879851 |
| Last Name Of The Provider | GIST |
| First Name Of The Provider | MORRIS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 608 35TH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOLINE |
| Zip Code Of The Provider | 612656145 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 10526 |
| Number Of Medicare Beneficiaries | 918 |
| Total Submitted Charge Amount | 1252213 |
| Total Medicare Allowed Amount | 330446.26 |
| Total Medicare Payment Amount | 244087.39 |
| Total Medicare Standardized Payment Amount | 255362.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 3884 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 199150 |
| Total Drug Medicare AllowedAmount | 80485.93 |
| Total Drug Medicare PaymentAmount | 61398.47 |
| Total Drug Medicare Standardized Payment Amount | 61398.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 6642 |
| Number Of Medicare Beneficiaries With Medical Services | 918 |
| Total Medical Submitted Charge Amount | 1053063 |
| Total Medical Medicare Allowed Amount | 249960.33 |
| Total Medical Medicare Payment Amount | 182688.92 |
| Total Medical Medicare Standardized Payment Amount | 193963.81 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 386 |
| Number Of Beneficiaries Age 75 to 84 | 334 |
| Number Of Beneficiaries Age Greater 84 | 156 |
| Number Of Female Beneficiaries | 275 |
| Number Of Male Beneficiaries | 643 |
| Number Of Non Hispanic White Beneficiaries | 830 |
| Number Of Black or African American Beneficiaries | 42 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 856 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1048 |