| National Provider Identifier [NPI]: | 1255355079 |
| Last Name Of The Provider | GIBSTINE |
| First Name Of The Provider | CONNIE |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3009 N BALLAS RD |
| Street Address 2 Of The Provider | STE. 208B |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631312322 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 5654 |
| Number Of Medicare Beneficiaries | 1076 |
| Total Submitted Charge Amount | 337976 |
| Total Medicare Allowed Amount | 255139.37 |
| Total Medicare Payment Amount | 179768.13 |
| Total Medicare Standardized Payment Amount | 182736.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1720 |
| Number Of Medicare Beneficiaries With Drug Services | 214 |
| Total Drug Submitted ChargeAmount | 5160 |
| Total Drug Medicare AllowedAmount | 3060.88 |
| Total Drug Medicare PaymentAmount | 2169.94 |
| Total Drug Medicare Standardized Payment Amount | 2169.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 3934 |
| Number Of Medicare Beneficiaries With Medical Services | 1076 |
| Total Medical Submitted Charge Amount | 332816 |
| Total Medical Medicare Allowed Amount | 252078.49 |
| Total Medical Medicare Payment Amount | 177598.19 |
| Total Medical Medicare Standardized Payment Amount | 180566.4 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 487 |
| Number Of Beneficiaries Age 75 to 84 | 359 |
| Number Of Beneficiaries Age Greater 84 | 182 |
| Number Of Female Beneficiaries | 640 |
| Number Of Male Beneficiaries | 436 |
| Number Of Non Hispanic White Beneficiaries | 1017 |
| Number Of Black or African American Beneficiaries | 28 |
| 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 | 1054 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9469 |