| National Provider Identifier [NPI]: | 1912959321 |
| Last Name Of The Provider | GIBBS |
| First Name Of The Provider | SCOTT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 740 MCKINLEY AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | KELLOGG |
| Zip Code Of The Provider | 838372523 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 790 |
| Number Of Medicare Beneficiaries | 261 |
| Total Submitted Charge Amount | 58301.15 |
| Total Medicare Allowed Amount | 31966.69 |
| Total Medicare Payment Amount | 17208.46 |
| Total Medicare Standardized Payment Amount | 23681.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 93 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 325.15 |
| Total Drug Medicare AllowedAmount | 136.93 |
| Total Drug Medicare PaymentAmount | 74.58 |
| Total Drug Medicare Standardized Payment Amount | 74.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 697 |
| Number Of Medicare Beneficiaries With Medical Services | 261 |
| Total Medical Submitted Charge Amount | 57976 |
| Total Medical Medicare Allowed Amount | 31829.76 |
| Total Medical Medicare Payment Amount | 17133.88 |
| Total Medical Medicare Standardized Payment Amount | 23606.95 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 101 |
| Number Of Beneficiaries Age 75 to 84 | 71 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 154 |
| Number Of Male Beneficiaries | 107 |
| Number Of Non Hispanic White Beneficiaries | 250 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 176 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1789 |