| National Provider Identifier [NPI]: | 1407030836 |
| Last Name Of The Provider | SHAW |
| First Name Of The Provider | JEROD |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 511 US HIGHWAY 281 |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARBLE FALLS |
| Zip Code Of The Provider | 786545708 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 22643 |
| Number Of Medicare Beneficiaries | 642 |
| Total Submitted Charge Amount | 3313296.5 |
| Total Medicare Allowed Amount | 763809.93 |
| Total Medicare Payment Amount | 593631.17 |
| Total Medicare Standardized Payment Amount | 573234.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 16114 |
| Number Of Medicare Beneficiaries With Drug Services | 375 |
| Total Drug Submitted ChargeAmount | 119201.5 |
| Total Drug Medicare AllowedAmount | 11664.9 |
| Total Drug Medicare PaymentAmount | 9067.23 |
| Total Drug Medicare Standardized Payment Amount | 9067.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 65 |
| Number Of Medical Services | 6529 |
| Number Of Medicare Beneficiaries With Medical Services | 641 |
| Total Medical Submitted Charge Amount | 3194095 |
| Total Medical Medicare Allowed Amount | 752145.03 |
| Total Medical Medicare Payment Amount | 584563.94 |
| Total Medical Medicare Standardized Payment Amount | 564166.89 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 90 |
| Number Of Beneficiaries Age 65 to 74 | 275 |
| Number Of Beneficiaries Age 75 to 84 | 202 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 416 |
| Number Of Male Beneficiaries | 226 |
| Number Of Non Hispanic White Beneficiaries | 610 |
| 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 | 560 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 82 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1534 |