| National Provider Identifier [NPI]: | 1144211541 |
| Last Name Of The Provider | GRIMBALL |
| First Name Of The Provider | EDWARD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 402 BOGLE ST |
| Street Address 2 Of The Provider | STE 3 |
| City Of The Provider | SOMERSET |
| Zip Code Of The Provider | 425032870 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 4913 |
| Number Of Medicare Beneficiaries | 1018 |
| Total Submitted Charge Amount | 892873 |
| Total Medicare Allowed Amount | 385978.14 |
| Total Medicare Payment Amount | 279298.45 |
| Total Medicare Standardized Payment Amount | 298329.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 138 |
| Number Of Medicare Beneficiaries With Drug Services | 99 |
| Total Drug Submitted ChargeAmount | 2471 |
| Total Drug Medicare AllowedAmount | 1780.5 |
| Total Drug Medicare PaymentAmount | 1734.92 |
| Total Drug Medicare Standardized Payment Amount | 1734.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 4775 |
| Number Of Medicare Beneficiaries With Medical Services | 1018 |
| Total Medical Submitted Charge Amount | 890402 |
| Total Medical Medicare Allowed Amount | 384197.64 |
| Total Medical Medicare Payment Amount | 277563.53 |
| Total Medical Medicare Standardized Payment Amount | 296594.58 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 369 |
| Number Of Beneficiaries Age 65 to 74 | 330 |
| Number Of Beneficiaries Age 75 to 84 | 224 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 546 |
| Number Of Male Beneficiaries | 472 |
| Number Of Non Hispanic White Beneficiaries | 995 |
| 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 | 483 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 535 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5012 |