| National Provider Identifier [NPI]: | 1831141027 |
| Last Name Of The Provider | TOM |
| First Name Of The Provider | JAIMIE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4320 SEMINARY RD |
| Street Address 2 Of The Provider | ALEXANDRIA HOSPITAL |
| City Of The Provider | ALEXANDRIA |
| Zip Code Of The Provider | 22304 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 521 |
| Number Of Medicare Beneficiaries | 308 |
| Total Submitted Charge Amount | 280422.31 |
| Total Medicare Allowed Amount | 55224.77 |
| Total Medicare Payment Amount | 39537.44 |
| Total Medicare Standardized Payment Amount | 42034.53 |
| 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 | 21 |
| Number Of Medical Services | 521 |
| Number Of Medicare Beneficiaries With Medical Services | 308 |
| Total Medical Submitted Charge Amount | 280422.31 |
| Total Medical Medicare Allowed Amount | 55224.77 |
| Total Medical Medicare Payment Amount | 39537.44 |
| Total Medical Medicare Standardized Payment Amount | 42034.53 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 110 |
| Number Of Beneficiaries Age 75 to 84 | 80 |
| Number Of Beneficiaries Age Greater 84 | 56 |
| Number Of Female Beneficiaries | 167 |
| Number Of Male Beneficiaries | 141 |
| Number Of Non Hispanic White Beneficiaries | 41 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 190 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 46 |
| Number Of Beneficiaries With Medicare Only Entitlement | 230 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 78 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0603 |