| National Provider Identifier [NPI]: | 1275518391 |
| Last Name Of The Provider | BROMBERG |
| First Name Of The Provider | JORDAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1095 NW SAINT LUCIE WEST BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT ST LUCIE |
| Zip Code Of The Provider | 349861719 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 2652 |
| Number Of Medicare Beneficiaries | 741 |
| Total Submitted Charge Amount | 480383 |
| Total Medicare Allowed Amount | 233996.35 |
| Total Medicare Payment Amount | 161728.7 |
| Total Medicare Standardized Payment Amount | 155681.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 297 |
| Number Of Medicare Beneficiaries With Drug Services | 267 |
| Total Drug Submitted ChargeAmount | 23080 |
| Total Drug Medicare AllowedAmount | 10883.77 |
| Total Drug Medicare PaymentAmount | 10655.61 |
| Total Drug Medicare Standardized Payment Amount | 10655.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 2355 |
| Number Of Medicare Beneficiaries With Medical Services | 741 |
| Total Medical Submitted Charge Amount | 457303 |
| Total Medical Medicare Allowed Amount | 223112.58 |
| Total Medical Medicare Payment Amount | 151073.09 |
| Total Medical Medicare Standardized Payment Amount | 145025.57 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 293 |
| Number Of Beneficiaries Age 75 to 84 | 305 |
| Number Of Beneficiaries Age Greater 84 | 128 |
| Number Of Female Beneficiaries | 378 |
| Number Of Male Beneficiaries | 363 |
| Number Of Non Hispanic White Beneficiaries | 702 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 727 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0523 |