| National Provider Identifier [NPI]: | 1588741599 |
| Last Name Of The Provider | GIBSON |
| First Name Of The Provider | SHELLEY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | FNP-BC, APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1310 BOSTON POST RD |
| Street Address 2 Of The Provider | MINUTECLINIC INSIDE CVS/PHARMACY #1949 |
| City Of The Provider | LARCHMONT |
| Zip Code Of The Provider | 105383905 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 331 |
| Number Of Medicare Beneficiaries | 157 |
| Total Submitted Charge Amount | 10529.67 |
| Total Medicare Allowed Amount | 10104.24 |
| Total Medicare Payment Amount | 8965.97 |
| Total Medicare Standardized Payment Amount | 9668.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 142 |
| Number Of Medicare Beneficiaries With Drug Services | 124 |
| Total Drug Submitted ChargeAmount | 4225.67 |
| Total Drug Medicare AllowedAmount | 4217.51 |
| Total Drug Medicare PaymentAmount | 4093.94 |
| Total Drug Medicare Standardized Payment Amount | 4093.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 189 |
| Number Of Medicare Beneficiaries With Medical Services | 157 |
| Total Medical Submitted Charge Amount | 6304 |
| Total Medical Medicare Allowed Amount | 5886.73 |
| Total Medical Medicare Payment Amount | 4872.03 |
| Total Medical Medicare Standardized Payment Amount | 5574.74 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 76 |
| Number Of Beneficiaries Age 75 to 84 | 56 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 102 |
| Number Of Male Beneficiaries | 55 |
| Number Of Non Hispanic White Beneficiaries | 137 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 7 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.769 |