| National Provider Identifier [NPI]: | 1497926356 |
| Last Name Of The Provider | GIBBS |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.A., CCC-A |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1760 MCCULLOCH BLVD N |
| Street Address 2 Of The Provider | STE. 100 |
| City Of The Provider | LAKE HAVASU CITY |
| Zip Code Of The Provider | 864036559 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Audiologist (billing independently) |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 958 |
| Number Of Medicare Beneficiaries | 457 |
| Total Submitted Charge Amount | 74806 |
| Total Medicare Allowed Amount | 27074.7 |
| Total Medicare Payment Amount | 19597.94 |
| Total Medicare Standardized Payment Amount | 19666.24 |
| 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 | 958 |
| Number Of Medicare Beneficiaries With Medical Services | 457 |
| Total Medical Submitted Charge Amount | 74806 |
| Total Medical Medicare Allowed Amount | 27074.7 |
| Total Medical Medicare Payment Amount | 19597.94 |
| Total Medical Medicare Standardized Payment Amount | 19666.24 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 204 |
| Number Of Beneficiaries Age 75 to 84 | 172 |
| Number Of Beneficiaries Age Greater 84 | 64 |
| Number Of Female Beneficiaries | 221 |
| Number Of Male Beneficiaries | 236 |
| Number Of Non Hispanic White Beneficiaries | 434 |
| 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 | 432 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0619 |