| National Provider Identifier [NPI]: | 1730142977 |
| Last Name Of The Provider | ULBRECHT |
| First Name Of The Provider | JAN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1850 E PARK AVE |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | STATE COLLEGE |
| Zip Code Of The Provider | 168036706 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Endocrinology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 413 |
| Number Of Medicare Beneficiaries | 240 |
| Total Submitted Charge Amount | 63706.3 |
| Total Medicare Allowed Amount | 36196.54 |
| Total Medicare Payment Amount | 26146.61 |
| Total Medicare Standardized Payment Amount | 28234.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 11 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 1196 |
| Total Drug Medicare AllowedAmount | 423.33 |
| Total Drug Medicare PaymentAmount | 384.62 |
| Total Drug Medicare Standardized Payment Amount | 384.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 402 |
| Number Of Medicare Beneficiaries With Medical Services | 240 |
| Total Medical Submitted Charge Amount | 62510.3 |
| Total Medical Medicare Allowed Amount | 35773.21 |
| Total Medical Medicare Payment Amount | 25761.99 |
| Total Medical Medicare Standardized Payment Amount | 27849.78 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 66 |
| Number Of Beneficiaries Age 65 to 74 | 102 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 100 |
| Number Of Non Hispanic White Beneficiaries | 229 |
| Number Of Black or African American Beneficiaries | |
| 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 | 183 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 71 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.9207 |