National Provider Identifier [NPI]: |
1942262399 |
Last Name Of The Provider |
JACKSON |
First Name Of The Provider |
J |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
303 N CENTENNIAL WAY |
Street Address 2 Of The Provider |
|
City Of The Provider |
MESA |
Zip Code Of The Provider |
852016733 |
State Code Of The Provider |
AZ |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physical Medicine and Rehabilitation |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
56 |
Number Of Services |
4511 |
Number Of Medicare Beneficiaries |
495 |
Total Submitted Charge Amount |
449626.39 |
Total Medicare Allowed Amount |
244750.29 |
Total Medicare Payment Amount |
183187.54 |
Total Medicare Standardized Payment Amount |
174551.94 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
948 |
Number Of Medicare Beneficiaries With Drug Services |
33 |
Total Drug Submitted ChargeAmount |
15884.08 |
Total Drug Medicare AllowedAmount |
4693.53 |
Total Drug Medicare PaymentAmount |
3667.53 |
Total Drug Medicare Standardized Payment Amount |
3667.53 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
50 |
Number Of Medical Services |
3563 |
Number Of Medicare Beneficiaries With Medical Services |
495 |
Total Medical Submitted Charge Amount |
433742.31 |
Total Medical Medicare Allowed Amount |
240056.76 |
Total Medical Medicare Payment Amount |
179520.01 |
Total Medical Medicare Standardized Payment Amount |
170884.41 |
Average Age Of Beneficiaries |
66 |
Number Of Beneficiaries Age Less65 |
186 |
Number Of Beneficiaries Age 65 to 74 |
170 |
Number Of Beneficiaries Age 75 to 84 |
93 |
Number Of Beneficiaries Age Greater 84 |
46 |
Number Of Female Beneficiaries |
274 |
Number Of Male Beneficiaries |
221 |
Number Of Non Hispanic White Beneficiaries |
412 |
Number Of Black or African American Beneficiaries |
28 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
27 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
350 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
145 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
37 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
58 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
10 |
Average HCC Risk Score Of Beneficiaries |
1.6989 |