| National Provider Identifier [NPI]: | 1821230475 |
| Last Name Of The Provider | FREESE |
| First Name Of The Provider | JARRED |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1501 E 3RD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | DELTA |
| Zip Code Of The Provider | 814162815 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 2472 |
| Number Of Medicare Beneficiaries | 901 |
| Total Submitted Charge Amount | 368364 |
| Total Medicare Allowed Amount | 203685.82 |
| Total Medicare Payment Amount | 148433 |
| Total Medicare Standardized Payment Amount | 148173.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 110 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 713 |
| Total Drug Medicare AllowedAmount | 497.37 |
| Total Drug Medicare PaymentAmount | 432.86 |
| Total Drug Medicare Standardized Payment Amount | 432.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 2362 |
| Number Of Medicare Beneficiaries With Medical Services | 901 |
| Total Medical Submitted Charge Amount | 367651 |
| Total Medical Medicare Allowed Amount | 203188.45 |
| Total Medical Medicare Payment Amount | 148000.14 |
| Total Medical Medicare Standardized Payment Amount | 147740.97 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 415 |
| Number Of Beneficiaries Age 75 to 84 | 278 |
| Number Of Beneficiaries Age Greater 84 | 128 |
| Number Of Female Beneficiaries | 496 |
| Number Of Male Beneficiaries | 405 |
| Number Of Non Hispanic White Beneficiaries | 842 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 763 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 138 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0646 |