| National Provider Identifier [NPI]: | 1710969076 |
| Last Name Of The Provider | LIEBELT |
| First Name Of The Provider | DONALD |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3515 SE 17TH ST |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | OCALA |
| Zip Code Of The Provider | 344715588 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 196 |
| Number Of Services | 19606 |
| Number Of Medicare Beneficiaries | 862 |
| Total Submitted Charge Amount | 1272748 |
| Total Medicare Allowed Amount | 607840.68 |
| Total Medicare Payment Amount | 481281.52 |
| Total Medicare Standardized Payment Amount | 479314.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 20 |
| Number Of Drug Services | 5522 |
| Number Of Medicare Beneficiaries With Drug Services | 206 |
| Total Drug Submitted ChargeAmount | 80256 |
| Total Drug Medicare AllowedAmount | 39931.72 |
| Total Drug Medicare PaymentAmount | 31654.85 |
| Total Drug Medicare Standardized Payment Amount | 31654.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 176 |
| Number Of Medical Services | 14084 |
| Number Of Medicare Beneficiaries With Medical Services | 862 |
| Total Medical Submitted Charge Amount | 1192492 |
| Total Medical Medicare Allowed Amount | 567908.96 |
| Total Medical Medicare Payment Amount | 449626.67 |
| Total Medical Medicare Standardized Payment Amount | 447659.86 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 361 |
| Number Of Beneficiaries Age 75 to 84 | 318 |
| Number Of Beneficiaries Age Greater 84 | 139 |
| Number Of Female Beneficiaries | 444 |
| Number Of Male Beneficiaries | 418 |
| Number Of Non Hispanic White Beneficiaries | 820 |
| Number Of Black or African American Beneficiaries | 21 |
| 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 | 811 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2357 |