| National Provider Identifier [NPI]: | 1598768046 |
| Last Name Of The Provider | GANGWISH |
| First Name Of The Provider | KIMBERLEY |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 620 N DIERS AVE |
| Street Address 2 Of The Provider | STE 200 |
| City Of The Provider | GRAND ISLAND |
| Zip Code Of The Provider | 688034984 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 383 |
| Number Of Medicare Beneficiaries | 99 |
| Total Submitted Charge Amount | 65310.82 |
| Total Medicare Allowed Amount | 14981.14 |
| Total Medicare Payment Amount | 10982.76 |
| Total Medicare Standardized Payment Amount | 13740.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 90 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 3915.34 |
| Total Drug Medicare AllowedAmount | 735.06 |
| Total Drug Medicare PaymentAmount | 691.61 |
| Total Drug Medicare Standardized Payment Amount | 691.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 293 |
| Number Of Medicare Beneficiaries With Medical Services | 99 |
| Total Medical Submitted Charge Amount | 61395.48 |
| Total Medical Medicare Allowed Amount | 14246.08 |
| Total Medical Medicare Payment Amount | 10291.15 |
| Total Medical Medicare Standardized Payment Amount | 13048.48 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 75 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 47 |
| Number Of Male Beneficiaries | 52 |
| Number Of Non Hispanic White Beneficiaries | 87 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7878 |