| National Provider Identifier [NPI]: | 1497184378 |
| Last Name Of The Provider | JACOBS |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | NP-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1900 MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | TEWKSBURY |
| Zip Code Of The Provider | 018762112 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 240 |
| Number Of Medicare Beneficiaries | 139 |
| Total Submitted Charge Amount | 11185.29 |
| Total Medicare Allowed Amount | 10190.53 |
| Total Medicare Payment Amount | 7979.69 |
| Total Medicare Standardized Payment Amount | 8931.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 71 |
| Number Of Medicare Beneficiaries With Drug Services | 69 |
| Total Drug Submitted ChargeAmount | 2395.29 |
| Total Drug Medicare AllowedAmount | 2276.73 |
| Total Drug Medicare PaymentAmount | 2168.48 |
| Total Drug Medicare Standardized Payment Amount | 2168.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 11 |
| Number Of Medical Services | 169 |
| Number Of Medicare Beneficiaries With Medical Services | 139 |
| Total Medical Submitted Charge Amount | 8790 |
| Total Medical Medicare Allowed Amount | 7913.8 |
| Total Medical Medicare Payment Amount | 5811.21 |
| Total Medical Medicare Standardized Payment Amount | 6762.67 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 81 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 90 |
| Number Of Male Beneficiaries | 49 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 115 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7449 |