| National Provider Identifier [NPI]: | 1487637922 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 236 W 6TH ST |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | RENO |
| Zip Code Of The Provider | 895034517 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 1793 |
| Number Of Medicare Beneficiaries | 832 |
| Total Submitted Charge Amount | 720564 |
| Total Medicare Allowed Amount | 234704.25 |
| Total Medicare Payment Amount | 180290.66 |
| Total Medicare Standardized Payment Amount | 176990.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 483 |
| Total Drug Medicare AllowedAmount | 214.29 |
| Total Drug Medicare PaymentAmount | 206.52 |
| Total Drug Medicare Standardized Payment Amount | 206.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 1773 |
| Number Of Medicare Beneficiaries With Medical Services | 832 |
| Total Medical Submitted Charge Amount | 720081 |
| Total Medical Medicare Allowed Amount | 234489.96 |
| Total Medical Medicare Payment Amount | 180084.14 |
| Total Medical Medicare Standardized Payment Amount | 176784.41 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 160 |
| Number Of Beneficiaries Age 65 to 74 | 382 |
| Number Of Beneficiaries Age 75 to 84 | 242 |
| Number Of Beneficiaries Age Greater 84 | 48 |
| Number Of Female Beneficiaries | 438 |
| Number Of Male Beneficiaries | 394 |
| Number Of Non Hispanic White Beneficiaries | 730 |
| Number Of Black or African American Beneficiaries | 20 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 644 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 188 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 56 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.9788 |