| National Provider Identifier [NPI]: | 1457555096 |
| Last Name Of The Provider | GARDNER |
| First Name Of The Provider | DIANE |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.S., CCC-A |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7440 N SHADELAND AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462502029 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Audiologist (billing independently) |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 831 |
| Number Of Medicare Beneficiaries | 484 |
| Total Submitted Charge Amount | 51137 |
| Total Medicare Allowed Amount | 26043.91 |
| Total Medicare Payment Amount | 16884.86 |
| Total Medicare Standardized Payment Amount | 18109.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 831 |
| Number Of Medicare Beneficiaries With Medical Services | 484 |
| Total Medical Submitted Charge Amount | 51137 |
| Total Medical Medicare Allowed Amount | 26043.91 |
| Total Medical Medicare Payment Amount | 16884.86 |
| Total Medical Medicare Standardized Payment Amount | 18109.33 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 219 |
| Number Of Beneficiaries Age 75 to 84 | 165 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 279 |
| Number Of Male Beneficiaries | 205 |
| Number Of Non Hispanic White Beneficiaries | 452 |
| Number Of Black or African American Beneficiaries | 16 |
| 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 | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9422 |