| National Provider Identifier [NPI]: | 1700890563 |
| Last Name Of The Provider | JACOBS |
| First Name Of The Provider | HARVEY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 25 CLYDE ROAD |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | SOMERSET |
| Zip Code Of The Provider | 088735038 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 3608 |
| Number Of Medicare Beneficiaries | 670 |
| Total Submitted Charge Amount | 291694 |
| Total Medicare Allowed Amount | 218371.55 |
| Total Medicare Payment Amount | 158019.46 |
| Total Medicare Standardized Payment Amount | 137747.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 21 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 210 |
| Total Drug Medicare AllowedAmount | 37.41 |
| Total Drug Medicare PaymentAmount | 29.31 |
| Total Drug Medicare Standardized Payment Amount | 29.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 3587 |
| Number Of Medicare Beneficiaries With Medical Services | 670 |
| Total Medical Submitted Charge Amount | 291484 |
| Total Medical Medicare Allowed Amount | 218334.14 |
| Total Medical Medicare Payment Amount | 157990.15 |
| Total Medical Medicare Standardized Payment Amount | 137718.58 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 237 |
| Number Of Beneficiaries Age 75 to 84 | 212 |
| Number Of Beneficiaries Age Greater 84 | 186 |
| Number Of Female Beneficiaries | 434 |
| Number Of Male Beneficiaries | 236 |
| Number Of Non Hispanic White Beneficiaries | 476 |
| Number Of Black or African American Beneficiaries | 145 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 587 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 83 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4915 |