| National Provider Identifier [NPI]: | 1275580573 |
| Last Name Of The Provider | GAITAN |
| First Name Of The Provider | JAIME |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1750 E GLENDALE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHOENIX |
| Zip Code Of The Provider | 850205505 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 10810 |
| Number Of Medicare Beneficiaries | 1277 |
| Total Submitted Charge Amount | 2460512.49 |
| Total Medicare Allowed Amount | 2425356.57 |
| Total Medicare Payment Amount | 1857276.8 |
| Total Medicare Standardized Payment Amount | 1859378.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 4836 |
| Number Of Medicare Beneficiaries With Drug Services | 450 |
| Total Drug Submitted ChargeAmount | 1873594.8 |
| Total Drug Medicare AllowedAmount | 1852972.59 |
| Total Drug Medicare PaymentAmount | 1446834.58 |
| Total Drug Medicare Standardized Payment Amount | 1446834.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 5974 |
| Number Of Medicare Beneficiaries With Medical Services | 1277 |
| Total Medical Submitted Charge Amount | 586917.69 |
| Total Medical Medicare Allowed Amount | 572383.98 |
| Total Medical Medicare Payment Amount | 410442.22 |
| Total Medical Medicare Standardized Payment Amount | 412544.07 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 412 |
| Number Of Beneficiaries Age 75 to 84 | 516 |
| Number Of Beneficiaries Age Greater 84 | 305 |
| Number Of Female Beneficiaries | 725 |
| Number Of Male Beneficiaries | 552 |
| Number Of Non Hispanic White Beneficiaries | 1174 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 62 |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1211 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 66 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3623 |