| National Provider Identifier [NPI]: | 1013022698 |
| Last Name Of The Provider | GIPSON |
| First Name Of The Provider | KELVIN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | D.P.M |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2600 HOSPITAL DR |
| Street Address 2 Of The Provider | DOCTORS MEMORIAL HOSPITAL/DOCTOR'S SPECIALTY CLINC |
| City Of The Provider | BONIFAY |
| Zip Code Of The Provider | 324254264 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 12796 |
| Number Of Medicare Beneficiaries | 2030 |
| Total Submitted Charge Amount | 667740 |
| Total Medicare Allowed Amount | 361473.71 |
| Total Medicare Payment Amount | 269287.91 |
| Total Medicare Standardized Payment Amount | 287824.51 |
| 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 | 17 |
| Number Of Medical Services | 12796 |
| Number Of Medicare Beneficiaries With Medical Services | 2030 |
| Total Medical Submitted Charge Amount | 667740 |
| Total Medical Medicare Allowed Amount | 361473.71 |
| Total Medical Medicare Payment Amount | 269287.91 |
| Total Medical Medicare Standardized Payment Amount | 287824.51 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 198 |
| Number Of Beneficiaries Age 65 to 74 | 387 |
| Number Of Beneficiaries Age 75 to 84 | 661 |
| Number Of Beneficiaries Age Greater 84 | 784 |
| Number Of Female Beneficiaries | 1412 |
| Number Of Male Beneficiaries | 618 |
| Number Of Non Hispanic White Beneficiaries | 1564 |
| Number Of Black or African American Beneficiaries | 437 |
| 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 | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 299 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1731 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 53 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 27 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 2.2013 |