| National Provider Identifier [NPI]: | 1386845022 |
| Last Name Of The Provider | JACOBS |
| First Name Of The Provider | MICAH |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9104 BABCOCK BLVD |
| Street Address 2 Of The Provider | SUITE 6118 |
| City Of The Provider | PITTSBURGH |
| Zip Code Of The Provider | 152375818 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 24791 |
| Number Of Medicare Beneficiaries | 274 |
| Total Submitted Charge Amount | 154941.96 |
| Total Medicare Allowed Amount | 117327.68 |
| Total Medicare Payment Amount | 90697.56 |
| Total Medicare Standardized Payment Amount | 92636.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 23624 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 20200 |
| Total Drug Medicare AllowedAmount | 15882.35 |
| Total Drug Medicare PaymentAmount | 12451.72 |
| Total Drug Medicare Standardized Payment Amount | 12451.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 1167 |
| Number Of Medicare Beneficiaries With Medical Services | 274 |
| Total Medical Submitted Charge Amount | 134741.96 |
| Total Medical Medicare Allowed Amount | 101445.33 |
| Total Medical Medicare Payment Amount | 78245.84 |
| Total Medical Medicare Standardized Payment Amount | 80184.76 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | 64 |
| Number Of Beneficiaries Age Greater 84 | 72 |
| Number Of Female Beneficiaries | 135 |
| Number Of Male Beneficiaries | 139 |
| Number Of Non Hispanic White Beneficiaries | 244 |
| 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 | 181 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 93 |
| Percent Of With Atrial Fibrillation | 33 |
| Percent Of With Alzheimers Disease or Dementia | 34 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 61 |
| Percent Of With Chronic Kidney Disease | 64 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 45 |
| Percent Of With Depression | 52 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 24 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 66 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 20 |
| Average HCC Risk Score Of Beneficiaries | 3.3592 |