| National Provider Identifier [NPI]: | 1447364963 |
| Last Name Of The Provider | LONG |
| First Name Of The Provider | JAY |
| 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 | 1190 E MISSOURI AVE |
| Street Address 2 Of The Provider | SUIE 160 |
| City Of The Provider | PHOENIX |
| Zip Code Of The Provider | 850142734 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 4257 |
| Number Of Medicare Beneficiaries | 430 |
| Total Submitted Charge Amount | 242245 |
| Total Medicare Allowed Amount | 172300.59 |
| Total Medicare Payment Amount | 117334.19 |
| Total Medicare Standardized Payment Amount | 120536.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 2009 |
| Number Of Medicare Beneficiaries With Drug Services | 213 |
| Total Drug Submitted ChargeAmount | 44792 |
| Total Drug Medicare AllowedAmount | 22944.71 |
| Total Drug Medicare PaymentAmount | 18786.24 |
| Total Drug Medicare Standardized Payment Amount | 18786.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 2248 |
| Number Of Medicare Beneficiaries With Medical Services | 430 |
| Total Medical Submitted Charge Amount | 197453 |
| Total Medical Medicare Allowed Amount | 149355.88 |
| Total Medical Medicare Payment Amount | 98547.95 |
| Total Medical Medicare Standardized Payment Amount | 101750.21 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 242 |
| Number Of Beneficiaries Age 75 to 84 | 103 |
| Number Of Beneficiaries Age Greater 84 | 67 |
| Number Of Female Beneficiaries | 225 |
| Number Of Male Beneficiaries | 205 |
| Number Of Non Hispanic White Beneficiaries | 401 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 45 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8474 |