| National Provider Identifier [NPI]: | 1275605586 |
| Last Name Of The Provider | LEISY |
| First Name Of The Provider | JERALD |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. P.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3310 EAST DOUGLAS AVE #101 |
| Street Address 2 Of The Provider | |
| City Of The Provider | WICHITA |
| Zip Code Of The Provider | 67208 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 5 |
| Number Of Services | 1498 |
| Number Of Medicare Beneficiaries | 70 |
| Total Submitted Charge Amount | 145805 |
| Total Medicare Allowed Amount | 100789.14 |
| Total Medicare Payment Amount | 77114.77 |
| Total Medicare Standardized Payment Amount | 78263.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 374 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 9670 |
| Total Drug Medicare AllowedAmount | 8054.05 |
| Total Drug Medicare PaymentAmount | 6245.45 |
| Total Drug Medicare Standardized Payment Amount | 6245.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 4 |
| Number Of Medical Services | 1124 |
| Number Of Medicare Beneficiaries With Medical Services | 70 |
| Total Medical Submitted Charge Amount | 136135 |
| Total Medical Medicare Allowed Amount | 92735.09 |
| Total Medical Medicare Payment Amount | 70869.32 |
| Total Medical Medicare Standardized Payment Amount | 72018.25 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 21 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 44 |
| Number Of Male Beneficiaries | 26 |
| Number Of Non Hispanic White Beneficiaries | 51 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 42 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 67 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 36 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0582 |