| National Provider Identifier [NPI]: | 1497749188 |
| Last Name Of The Provider | SABEY |
| First Name Of The Provider | KIMBERLEY |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1040 DIVISION ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MAUSTON |
| Zip Code Of The Provider | 539481931 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 90 |
| Number Of Services | 530 |
| Number Of Medicare Beneficiaries | 79 |
| Total Submitted Charge Amount | 73610.8 |
| Total Medicare Allowed Amount | 21226.66 |
| Total Medicare Payment Amount | 16706.24 |
| Total Medicare Standardized Payment Amount | 17224.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 23 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1343 |
| Total Drug Medicare AllowedAmount | 906.81 |
| Total Drug Medicare PaymentAmount | 888.33 |
| Total Drug Medicare Standardized Payment Amount | 888.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 85 |
| Number Of Medical Services | 507 |
| Number Of Medicare Beneficiaries With Medical Services | 79 |
| Total Medical Submitted Charge Amount | 72267.8 |
| Total Medical Medicare Allowed Amount | 20319.85 |
| Total Medical Medicare Payment Amount | 15817.91 |
| Total Medical Medicare Standardized Payment Amount | 16336.27 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 38 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 46 |
| Number Of Male Beneficiaries | 33 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 60 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.0359 |