| National Provider Identifier [NPI]: | 1053391342 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 17800 NEWBURGH RD |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | LIVONIA |
| Zip Code Of The Provider | 481522700 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 124 |
| Number Of Services | 7881 |
| Number Of Medicare Beneficiaries | 397 |
| Total Submitted Charge Amount | 259686.06 |
| Total Medicare Allowed Amount | 172044.78 |
| Total Medicare Payment Amount | 140502.75 |
| Total Medicare Standardized Payment Amount | 139866.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 276 |
| Number Of Medicare Beneficiaries With Drug Services | 155 |
| Total Drug Submitted ChargeAmount | 5066 |
| Total Drug Medicare AllowedAmount | 2462.38 |
| Total Drug Medicare PaymentAmount | 2341.68 |
| Total Drug Medicare Standardized Payment Amount | 2341.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 110 |
| Number Of Medical Services | 7605 |
| Number Of Medicare Beneficiaries With Medical Services | 397 |
| Total Medical Submitted Charge Amount | 254620.06 |
| Total Medical Medicare Allowed Amount | 169582.4 |
| Total Medical Medicare Payment Amount | 138161.07 |
| Total Medical Medicare Standardized Payment Amount | 137525.13 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 92 |
| Number Of Beneficiaries Age 65 to 74 | 166 |
| Number Of Beneficiaries Age 75 to 84 | 107 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 245 |
| Number Of Male Beneficiaries | 152 |
| Number Of Non Hispanic White Beneficiaries | 337 |
| Number Of Black or African American Beneficiaries | 45 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 327 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 70 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1647 |