| National Provider Identifier [NPI]: | 1710203435 |
| Last Name Of The Provider | BALSEIRO |
| First Name Of The Provider | JESSE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4348 SOUTHPOINT BLVD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322160986 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nuclear Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 354 |
| Number Of Medicare Beneficiaries | 106 |
| Total Submitted Charge Amount | 41757 |
| Total Medicare Allowed Amount | 33041.94 |
| Total Medicare Payment Amount | 24808.3 |
| Total Medicare Standardized Payment Amount | 24671.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 354 |
| Number Of Medicare Beneficiaries With Medical Services | 106 |
| Total Medical Submitted Charge Amount | 41757 |
| Total Medical Medicare Allowed Amount | 33041.94 |
| Total Medical Medicare Payment Amount | 24808.3 |
| Total Medical Medicare Standardized Payment Amount | 24671.78 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 42 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 70 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | 92 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 68 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 38 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 42 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 67 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 64 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 1.84 |