| National Provider Identifier [NPI]: | 1730132556 |
| Last Name Of The Provider | JACOB |
| First Name Of The Provider | MINA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D.,FACC,FSCAI |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2300 MANCHESTER EXPY |
| Street Address 2 Of The Provider | SUITE 2001 |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 319046802 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 2885 |
| Number Of Medicare Beneficiaries | 975 |
| Total Submitted Charge Amount | 1424814.5 |
| Total Medicare Allowed Amount | 329121.47 |
| Total Medicare Payment Amount | 244972.94 |
| Total Medicare Standardized Payment Amount | 249998.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 176 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 27624 |
| Total Drug Medicare AllowedAmount | 8728.01 |
| Total Drug Medicare PaymentAmount | 6664.21 |
| Total Drug Medicare Standardized Payment Amount | 6664.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 2709 |
| Number Of Medicare Beneficiaries With Medical Services | 975 |
| Total Medical Submitted Charge Amount | 1397190.5 |
| Total Medical Medicare Allowed Amount | 320393.46 |
| Total Medical Medicare Payment Amount | 238308.73 |
| Total Medical Medicare Standardized Payment Amount | 243334.61 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 140 |
| Number Of Beneficiaries Age 65 to 74 | 336 |
| Number Of Beneficiaries Age 75 to 84 | 340 |
| Number Of Beneficiaries Age Greater 84 | 159 |
| Number Of Female Beneficiaries | 519 |
| Number Of Male Beneficiaries | 456 |
| Number Of Non Hispanic White Beneficiaries | 730 |
| Number Of Black or African American Beneficiaries | 221 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 745 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 230 |
| Percent Of With Atrial Fibrillation | 39 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 51 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 74 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.145 |