| National Provider Identifier [NPI]: | 1295795755 |
| Last Name Of The Provider | GAMBORG |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1114 STELLY LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | SULPHUR |
| Zip Code Of The Provider | 706635139 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 98 |
| Number Of Services | 6984 |
| Number Of Medicare Beneficiaries | 720 |
| Total Submitted Charge Amount | 538104.64 |
| Total Medicare Allowed Amount | 375717.94 |
| Total Medicare Payment Amount | 265388.62 |
| Total Medicare Standardized Payment Amount | 267312.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 1494 |
| Number Of Medicare Beneficiaries With Drug Services | 337 |
| Total Drug Submitted ChargeAmount | 20269.5 |
| Total Drug Medicare AllowedAmount | 7568.14 |
| Total Drug Medicare PaymentAmount | 7201.21 |
| Total Drug Medicare Standardized Payment Amount | 7201.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 89 |
| Number Of Medical Services | 5490 |
| Number Of Medicare Beneficiaries With Medical Services | 720 |
| Total Medical Submitted Charge Amount | 517835.14 |
| Total Medical Medicare Allowed Amount | 368149.8 |
| Total Medical Medicare Payment Amount | 258187.41 |
| Total Medical Medicare Standardized Payment Amount | 260111.61 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 323 |
| Number Of Beneficiaries Age 75 to 84 | 248 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 384 |
| Number Of Male Beneficiaries | 336 |
| Number Of Non Hispanic White Beneficiaries | 672 |
| 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 | 633 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 87 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4546 |