| National Provider Identifier [NPI]: | 1699768119 |
| Last Name Of The Provider | BENNETT |
| First Name Of The Provider | JERRY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 706 LEGEND LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHERMAN |
| Zip Code Of The Provider | 750925421 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 2163 |
| Number Of Medicare Beneficiaries | 1322 |
| Total Submitted Charge Amount | 709769.76 |
| Total Medicare Allowed Amount | 149010.01 |
| Total Medicare Payment Amount | 121659.22 |
| Total Medicare Standardized Payment Amount | 126199.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 695 |
| Number Of Medicare Beneficiaries With Drug Services | 675 |
| Total Drug Submitted ChargeAmount | 23047.19 |
| Total Drug Medicare AllowedAmount | 23047.19 |
| Total Drug Medicare PaymentAmount | 22583.66 |
| Total Drug Medicare Standardized Payment Amount | 22583.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 1468 |
| Number Of Medicare Beneficiaries With Medical Services | 1322 |
| Total Medical Submitted Charge Amount | 686722.57 |
| Total Medical Medicare Allowed Amount | 125962.82 |
| Total Medical Medicare Payment Amount | 99075.56 |
| Total Medical Medicare Standardized Payment Amount | 103616.32 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 243 |
| Number Of Beneficiaries Age 65 to 74 | 458 |
| Number Of Beneficiaries Age 75 to 84 | 417 |
| Number Of Beneficiaries Age Greater 84 | 204 |
| Number Of Female Beneficiaries | 739 |
| Number Of Male Beneficiaries | 583 |
| Number Of Non Hispanic White Beneficiaries | 1209 |
| Number Of Black or African American Beneficiaries | 72 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1024 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 298 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4431 |