| National Provider Identifier [NPI]: | 1184614018 |
| Last Name Of The Provider | LEVENTHAL |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 SAN PABLO RD S |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322241865 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 5884 |
| Number Of Medicare Beneficiaries | 754 |
| Total Submitted Charge Amount | 170478.9 |
| Total Medicare Allowed Amount | 140108.64 |
| Total Medicare Payment Amount | 104316.55 |
| Total Medicare Standardized Payment Amount | 112813.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 4129 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 3911.39 |
| Total Drug Medicare AllowedAmount | 3092.09 |
| Total Drug Medicare PaymentAmount | 2148.34 |
| Total Drug Medicare Standardized Payment Amount | 2148.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 1755 |
| Number Of Medicare Beneficiaries With Medical Services | 754 |
| Total Medical Submitted Charge Amount | 166567.51 |
| Total Medical Medicare Allowed Amount | 137016.55 |
| Total Medical Medicare Payment Amount | 102168.21 |
| Total Medical Medicare Standardized Payment Amount | 110665.45 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | 322 |
| Number Of Beneficiaries Age 75 to 84 | 281 |
| Number Of Beneficiaries Age Greater 84 | 74 |
| Number Of Female Beneficiaries | 409 |
| Number Of Male Beneficiaries | 345 |
| Number Of Non Hispanic White Beneficiaries | 685 |
| Number Of Black or African American Beneficiaries | 40 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 715 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 52 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5751 |