| National Provider Identifier [NPI]: | 1972529972 |
| Last Name Of The Provider | DIBBLE |
| First Name Of The Provider | JUDITH |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3023 N BALLAS ROAD SUITE 500 |
| Street Address 2 Of The Provider | MISSOURI BAPTIST MEDICAL CENTER PROFESSIONAL BUILDING D |
| City Of The Provider | ST LOUIS |
| Zip Code Of The Provider | 63131 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 2235 |
| Number Of Medicare Beneficiaries | 416 |
| Total Submitted Charge Amount | 158499 |
| Total Medicare Allowed Amount | 102500.56 |
| Total Medicare Payment Amount | 80351.17 |
| Total Medicare Standardized Payment Amount | 82598.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 850 |
| Number Of Medicare Beneficiaries With Drug Services | 101 |
| Total Drug Submitted ChargeAmount | 20923 |
| Total Drug Medicare AllowedAmount | 14137.15 |
| Total Drug Medicare PaymentAmount | 11550.24 |
| Total Drug Medicare Standardized Payment Amount | 11550.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 1385 |
| Number Of Medicare Beneficiaries With Medical Services | 416 |
| Total Medical Submitted Charge Amount | 137576 |
| Total Medical Medicare Allowed Amount | 88363.41 |
| Total Medical Medicare Payment Amount | 68800.93 |
| Total Medical Medicare Standardized Payment Amount | 71048.48 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 204 |
| Number Of Beneficiaries Age 75 to 84 | 147 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 326 |
| Number Of Male Beneficiaries | 90 |
| Number Of Non Hispanic White Beneficiaries | 352 |
| Number Of Black or African American Beneficiaries | 53 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8414 |