| National Provider Identifier [NPI]: | 1386840742 |
| Last Name Of The Provider | GIBSON |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 S PARK ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MADISON |
| Zip Code Of The Provider | 537151830 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 198 |
| Number Of Services | 23526 |
| Number Of Medicare Beneficiaries | 3272 |
| Total Submitted Charge Amount | 3240808.25 |
| Total Medicare Allowed Amount | 309628.34 |
| Total Medicare Payment Amount | 239444.28 |
| Total Medicare Standardized Payment Amount | 250904.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 18424 |
| Number Of Medicare Beneficiaries With Drug Services | 239 |
| Total Drug Submitted ChargeAmount | 17816.75 |
| Total Drug Medicare AllowedAmount | 6982.34 |
| Total Drug Medicare PaymentAmount | 4884.07 |
| Total Drug Medicare Standardized Payment Amount | 4884.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 190 |
| Number Of Medical Services | 5102 |
| Number Of Medicare Beneficiaries With Medical Services | 3272 |
| Total Medical Submitted Charge Amount | 3222991.5 |
| Total Medical Medicare Allowed Amount | 302646 |
| Total Medical Medicare Payment Amount | 234560.21 |
| Total Medical Medicare Standardized Payment Amount | 246020.21 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 600 |
| Number Of Beneficiaries Age 65 to 74 | 1201 |
| Number Of Beneficiaries Age 75 to 84 | 934 |
| Number Of Beneficiaries Age Greater 84 | 537 |
| Number Of Female Beneficiaries | 2082 |
| Number Of Male Beneficiaries | 1190 |
| Number Of Non Hispanic White Beneficiaries | 3104 |
| Number Of Black or African American Beneficiaries | 70 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 46 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2530 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 742 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.2892 |