| National Provider Identifier [NPI]: | 1962405928 |
| Last Name Of The Provider | ELLEN |
| First Name Of The Provider | JASON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4444 S HARVARD AVE |
| Street Address 2 Of The Provider | STE 300 |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741352611 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 5844 |
| Number Of Medicare Beneficiaries | 1723 |
| Total Submitted Charge Amount | 526492.01 |
| Total Medicare Allowed Amount | 452325.83 |
| Total Medicare Payment Amount | 326143.07 |
| Total Medicare Standardized Payment Amount | 361603.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 737 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 3987.74 |
| Total Drug Medicare AllowedAmount | 3951.29 |
| Total Drug Medicare PaymentAmount | 3097.05 |
| Total Drug Medicare Standardized Payment Amount | 3097.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 5107 |
| Number Of Medicare Beneficiaries With Medical Services | 1723 |
| Total Medical Submitted Charge Amount | 522504.27 |
| Total Medical Medicare Allowed Amount | 448374.54 |
| Total Medical Medicare Payment Amount | 323046.02 |
| Total Medical Medicare Standardized Payment Amount | 358506.6 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 147 |
| Number Of Beneficiaries Age 65 to 74 | 885 |
| Number Of Beneficiaries Age 75 to 84 | 559 |
| Number Of Beneficiaries Age Greater 84 | 132 |
| Number Of Female Beneficiaries | 1055 |
| Number Of Male Beneficiaries | 668 |
| Number Of Non Hispanic White Beneficiaries | 1312 |
| Number Of Black or African American Beneficiaries | 94 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | 279 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1464 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 259 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0689 |