| National Provider Identifier [NPI]: | 1922028828 |
| Last Name Of The Provider | CARRICO |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10901 E 48TH ST S |
| Street Address 2 Of The Provider | |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 74146 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 129 |
| Number Of Services | 12261 |
| Number Of Medicare Beneficiaries | 907 |
| Total Submitted Charge Amount | 902979.16 |
| Total Medicare Allowed Amount | 275656.49 |
| Total Medicare Payment Amount | 205235.79 |
| Total Medicare Standardized Payment Amount | 223612.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 7494 |
| Number Of Medicare Beneficiaries With Drug Services | 144 |
| Total Drug Submitted ChargeAmount | 172577 |
| Total Drug Medicare AllowedAmount | 50845.08 |
| Total Drug Medicare PaymentAmount | 39429.86 |
| Total Drug Medicare Standardized Payment Amount | 39429.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 113 |
| Number Of Medical Services | 4767 |
| Number Of Medicare Beneficiaries With Medical Services | 907 |
| Total Medical Submitted Charge Amount | 730402.16 |
| Total Medical Medicare Allowed Amount | 224811.41 |
| Total Medical Medicare Payment Amount | 165805.93 |
| Total Medical Medicare Standardized Payment Amount | 184182.63 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 113 |
| Number Of Beneficiaries Age 65 to 74 | 368 |
| Number Of Beneficiaries Age 75 to 84 | 302 |
| Number Of Beneficiaries Age Greater 84 | 124 |
| Number Of Female Beneficiaries | 214 |
| Number Of Male Beneficiaries | 693 |
| Number Of Non Hispanic White Beneficiaries | 787 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | 57 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 786 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 121 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3322 |