| National Provider Identifier [NPI]: | 1003866104 |
| Last Name Of The Provider | CRIST |
| First Name Of The Provider | GENE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10988 BARTEL BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | GALENA |
| Zip Code Of The Provider | 610368222 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 2541 |
| Number Of Medicare Beneficiaries | 531 |
| Total Submitted Charge Amount | 137139 |
| Total Medicare Allowed Amount | 76264.67 |
| Total Medicare Payment Amount | 54419.87 |
| Total Medicare Standardized Payment Amount | 56554.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 201 |
| Number Of Medicare Beneficiaries With Drug Services | 168 |
| Total Drug Submitted ChargeAmount | 7032.5 |
| Total Drug Medicare AllowedAmount | 5958.55 |
| Total Drug Medicare PaymentAmount | 5802.47 |
| Total Drug Medicare Standardized Payment Amount | 5802.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 2340 |
| Number Of Medicare Beneficiaries With Medical Services | 531 |
| Total Medical Submitted Charge Amount | 130106.5 |
| Total Medical Medicare Allowed Amount | 70306.12 |
| Total Medical Medicare Payment Amount | 48617.4 |
| Total Medical Medicare Standardized Payment Amount | 50752.29 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 233 |
| Number Of Beneficiaries Age 75 to 84 | 160 |
| Number Of Beneficiaries Age Greater 84 | 90 |
| Number Of Female Beneficiaries | 261 |
| Number Of Male Beneficiaries | 270 |
| Number Of Non Hispanic White Beneficiaries | 516 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 473 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 58 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9348 |