National Provider Identifier [NPI]: |
1578670055 |
Last Name Of The Provider |
JACKSON |
First Name Of The Provider |
OKANTA |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1707 RIGGINS RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
TALLAHASSEE |
Zip Code Of The Provider |
323085317 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Dermatology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
67 |
Number Of Services |
4313 |
Number Of Medicare Beneficiaries |
840 |
Total Submitted Charge Amount |
1708249 |
Total Medicare Allowed Amount |
730956.45 |
Total Medicare Payment Amount |
555852.5 |
Total Medicare Standardized Payment Amount |
545465.12 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
43 |
Number Of Medicare Beneficiaries With Drug Services |
22 |
Total Drug Submitted ChargeAmount |
11302 |
Total Drug Medicare AllowedAmount |
9810.11 |
Total Drug Medicare PaymentAmount |
7674.48 |
Total Drug Medicare Standardized Payment Amount |
7674.48 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
65 |
Number Of Medical Services |
4270 |
Number Of Medicare Beneficiaries With Medical Services |
840 |
Total Medical Submitted Charge Amount |
1696947 |
Total Medical Medicare Allowed Amount |
721146.34 |
Total Medical Medicare Payment Amount |
548178.02 |
Total Medical Medicare Standardized Payment Amount |
537790.64 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
29 |
Number Of Beneficiaries Age 65 to 74 |
366 |
Number Of Beneficiaries Age 75 to 84 |
314 |
Number Of Beneficiaries Age Greater 84 |
131 |
Number Of Female Beneficiaries |
376 |
Number Of Male Beneficiaries |
464 |
Number Of Non Hispanic White Beneficiaries |
782 |
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 |
788 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
52 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
15 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
65 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
38 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
0.9826 |