| National Provider Identifier [NPI]: | 1023243623 |
| Last Name Of The Provider | JETLEY |
| First Name Of The Provider | AJAY |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3045 ARLINGTON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TOLEDO |
| Zip Code Of The Provider | 436142570 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 1368 |
| Number Of Medicare Beneficiaries | 1182 |
| Total Submitted Charge Amount | 1042905 |
| Total Medicare Allowed Amount | 209135.07 |
| Total Medicare Payment Amount | 161955.64 |
| Total Medicare Standardized Payment Amount | 151634.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 1368 |
| Number Of Medicare Beneficiaries With Medical Services | 1182 |
| Total Medical Submitted Charge Amount | 1042905 |
| Total Medical Medicare Allowed Amount | 209135.07 |
| Total Medical Medicare Payment Amount | 161955.64 |
| Total Medical Medicare Standardized Payment Amount | 151634.38 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 141 |
| Number Of Beneficiaries Age 65 to 74 | 298 |
| Number Of Beneficiaries Age 75 to 84 | 355 |
| Number Of Beneficiaries Age Greater 84 | 388 |
| Number Of Female Beneficiaries | 697 |
| Number Of Male Beneficiaries | 485 |
| Number Of Non Hispanic White Beneficiaries | 843 |
| Number Of Black or African American Beneficiaries | 125 |
| Number Of AsianPacific Islander Beneficiaries | 46 |
| Number Of Hispanic Beneficiaries | 144 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 916 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 266 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 74 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0078 |