| National Provider Identifier [NPI]: | 1528016318 |
| Last Name Of The Provider | JACOUB |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9940 TALBERT AVE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | FOUNTAIN VALLEY |
| Zip Code Of The Provider | 927085153 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 122 |
| Number Of Services | 117690 |
| Number Of Medicare Beneficiaries | 439 |
| Total Submitted Charge Amount | 3623179.29 |
| Total Medicare Allowed Amount | 1905571.5 |
| Total Medicare Payment Amount | 1472406.51 |
| Total Medicare Standardized Payment Amount | 1432349.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 73 |
| Number Of Drug Services | 110977 |
| Number Of Medicare Beneficiaries With Drug Services | 134 |
| Total Drug Submitted ChargeAmount | 2776364.28 |
| Total Drug Medicare AllowedAmount | 1472992.96 |
| Total Drug Medicare PaymentAmount | 1147736.92 |
| Total Drug Medicare Standardized Payment Amount | 1147736.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 6713 |
| Number Of Medicare Beneficiaries With Medical Services | 439 |
| Total Medical Submitted Charge Amount | 846815.01 |
| Total Medical Medicare Allowed Amount | 432578.54 |
| Total Medical Medicare Payment Amount | 324669.59 |
| Total Medical Medicare Standardized Payment Amount | 284613.07 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 183 |
| Number Of Beneficiaries Age 75 to 84 | 140 |
| Number Of Beneficiaries Age Greater 84 | 68 |
| Number Of Female Beneficiaries | 258 |
| Number Of Male Beneficiaries | 181 |
| Number Of Non Hispanic White Beneficiaries | 295 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 86 |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 296 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 143 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 43 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.1161 |