| National Provider Identifier [NPI]: | 1548299159 |
| Last Name Of The Provider | GIBBS |
| First Name Of The Provider | ROSE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 106 W MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MONCKS CORNER |
| Zip Code Of The Provider | 29461 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 922 |
| Number Of Medicare Beneficiaries | 261 |
| Total Submitted Charge Amount | 99491 |
| Total Medicare Allowed Amount | 47744.62 |
| Total Medicare Payment Amount | 36573.31 |
| Total Medicare Standardized Payment Amount | 39034.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 189 |
| Number Of Medicare Beneficiaries With Drug Services | 134 |
| Total Drug Submitted ChargeAmount | 6768 |
| Total Drug Medicare AllowedAmount | 2197.71 |
| Total Drug Medicare PaymentAmount | 2137.83 |
| Total Drug Medicare Standardized Payment Amount | 2137.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 733 |
| Number Of Medicare Beneficiaries With Medical Services | 261 |
| Total Medical Submitted Charge Amount | 92723 |
| Total Medical Medicare Allowed Amount | 45546.91 |
| Total Medical Medicare Payment Amount | 34435.48 |
| Total Medical Medicare Standardized Payment Amount | 36896.68 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 121 |
| Number Of Beneficiaries Age 75 to 84 | 56 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 169 |
| Number Of Male Beneficiaries | 92 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 212 |
| 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 | 193 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1918 |