| National Provider Identifier [NPI]: | 1144535485 |
| Last Name Of The Provider | GIBBONS |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | CNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1005 BROADWAY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | QUINCY |
| Zip Code Of The Provider | 623012834 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 1341 |
| Number Of Medicare Beneficiaries | 317 |
| Total Submitted Charge Amount | 167047.98 |
| Total Medicare Allowed Amount | 55625.9 |
| Total Medicare Payment Amount | 42959.7 |
| Total Medicare Standardized Payment Amount | 51758.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 635 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 22116.44 |
| Total Drug Medicare AllowedAmount | 7243.5 |
| Total Drug Medicare PaymentAmount | 5687.72 |
| Total Drug Medicare Standardized Payment Amount | 5687.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 706 |
| Number Of Medicare Beneficiaries With Medical Services | 317 |
| Total Medical Submitted Charge Amount | 144931.54 |
| Total Medical Medicare Allowed Amount | 48382.4 |
| Total Medical Medicare Payment Amount | 37271.98 |
| Total Medical Medicare Standardized Payment Amount | 46070.88 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 124 |
| Number Of Beneficiaries Age 75 to 84 | 127 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 183 |
| Number Of Male Beneficiaries | 134 |
| Number Of Non Hispanic White Beneficiaries | 302 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 258 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 60 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 2.1129 |