| National Provider Identifier [NPI]: | 1780694794 |
| Last Name Of The Provider | COMBELLICK |
| First Name Of The Provider | JACQUELINE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11700 N MERIDIAN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CARMEL |
| Zip Code Of The Provider | 460324656 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 470 |
| Number Of Medicare Beneficiaries | 397 |
| Total Submitted Charge Amount | 158724 |
| Total Medicare Allowed Amount | 67589.29 |
| Total Medicare Payment Amount | 51934.94 |
| Total Medicare Standardized Payment Amount | 54493.5 |
| 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 | 15 |
| Number Of Medical Services | 470 |
| Number Of Medicare Beneficiaries With Medical Services | 397 |
| Total Medical Submitted Charge Amount | 158724 |
| Total Medical Medicare Allowed Amount | 67589.29 |
| Total Medical Medicare Payment Amount | 51934.94 |
| Total Medical Medicare Standardized Payment Amount | 54493.5 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 70 |
| Number Of Beneficiaries Age 65 to 74 | 128 |
| Number Of Beneficiaries Age 75 to 84 | 110 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 245 |
| Number Of Male Beneficiaries | 152 |
| Number Of Non Hispanic White Beneficiaries | 341 |
| Number Of Black or African American Beneficiaries | 45 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 317 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 80 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.0253 |