| National Provider Identifier [NPI]: | 1982639779 |
| Last Name Of The Provider | GIBSON |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2500 NORTH STATE STREET |
| Street Address 2 Of The Provider | DEPARTMENT OF MEDICINE DIVISION OF GERIATRICS |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 392164500 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 960 |
| Number Of Medicare Beneficiaries | 440 |
| Total Submitted Charge Amount | 128082.5 |
| Total Medicare Allowed Amount | 58900.39 |
| Total Medicare Payment Amount | 42609.22 |
| Total Medicare Standardized Payment Amount | 54707.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 106 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 4149.5 |
| Total Drug Medicare AllowedAmount | 2174.39 |
| Total Drug Medicare PaymentAmount | 1959.82 |
| Total Drug Medicare Standardized Payment Amount | 1959.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 854 |
| Number Of Medicare Beneficiaries With Medical Services | 440 |
| Total Medical Submitted Charge Amount | 123933 |
| Total Medical Medicare Allowed Amount | 56726 |
| Total Medical Medicare Payment Amount | 40649.4 |
| Total Medical Medicare Standardized Payment Amount | 52747.72 |
| Average Age Of Beneficiaries | 83 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 177 |
| Number Of Beneficiaries Age Greater 84 | 191 |
| Number Of Female Beneficiaries | 335 |
| Number Of Male Beneficiaries | 105 |
| Number Of Non Hispanic White Beneficiaries | 345 |
| 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 | 358 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 82 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 51 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 34 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4374 |