| National Provider Identifier [NPI]: | 1669556130 |
| Last Name Of The Provider | TIBBS |
| First Name Of The Provider | LAURIE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 NORTH LOGAN |
| Street Address 2 Of The Provider | SUITE 105 |
| City Of The Provider | DANVILLE |
| Zip Code Of The Provider | 61832 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 2572 |
| Number Of Medicare Beneficiaries | 178 |
| Total Submitted Charge Amount | 189597 |
| Total Medicare Allowed Amount | 54586.76 |
| Total Medicare Payment Amount | 37635.26 |
| Total Medicare Standardized Payment Amount | 45881.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 775 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 1411 |
| Total Drug Medicare AllowedAmount | 579.46 |
| Total Drug Medicare PaymentAmount | 493.87 |
| Total Drug Medicare Standardized Payment Amount | 493.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 1797 |
| Number Of Medicare Beneficiaries With Medical Services | 178 |
| Total Medical Submitted Charge Amount | 188186 |
| Total Medical Medicare Allowed Amount | 54007.3 |
| Total Medical Medicare Payment Amount | 37141.39 |
| Total Medical Medicare Standardized Payment Amount | 45387.34 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 86 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 114 |
| Number Of Male Beneficiaries | 64 |
| Number Of Non Hispanic White Beneficiaries | 149 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 122 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 56 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9525 |