| National Provider Identifier [NPI]: | 1558383893 |
| Last Name Of The Provider | HALSELL |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9308 S TOLEDO AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741372739 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 10566 |
| Number Of Medicare Beneficiaries | 654 |
| Total Submitted Charge Amount | 1050585.36 |
| Total Medicare Allowed Amount | 365076.23 |
| Total Medicare Payment Amount | 302677.27 |
| Total Medicare Standardized Payment Amount | 296583.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 3105 |
| Number Of Medicare Beneficiaries With Drug Services | 64 |
| Total Drug Submitted ChargeAmount | 6314 |
| Total Drug Medicare AllowedAmount | 668.17 |
| Total Drug Medicare PaymentAmount | 499.29 |
| Total Drug Medicare Standardized Payment Amount | 499.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 7461 |
| Number Of Medicare Beneficiaries With Medical Services | 654 |
| Total Medical Submitted Charge Amount | 1044271.36 |
| Total Medical Medicare Allowed Amount | 364408.06 |
| Total Medical Medicare Payment Amount | 302177.98 |
| Total Medical Medicare Standardized Payment Amount | 296083.83 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 236 |
| Number Of Beneficiaries Age 65 to 74 | 254 |
| Number Of Beneficiaries Age 75 to 84 | 135 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 393 |
| Number Of Male Beneficiaries | 261 |
| Number Of Non Hispanic White Beneficiaries | 553 |
| Number Of Black or African American Beneficiaries | 24 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 66 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 477 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 177 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2401 |