| National Provider Identifier [NPI]: | 1306849765 |
| Last Name Of The Provider | JACOB |
| First Name Of The Provider | PRADEEP |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 975 E 3RD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHATTANOOGA |
| Zip Code Of The Provider | 374032103 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 1284 |
| Number Of Medicare Beneficiaries | 919 |
| Total Submitted Charge Amount | 381446 |
| Total Medicare Allowed Amount | 58055.14 |
| Total Medicare Payment Amount | 42502.37 |
| Total Medicare Standardized Payment Amount | 45505.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 1284 |
| Number Of Medicare Beneficiaries With Medical Services | 919 |
| Total Medical Submitted Charge Amount | 381446 |
| Total Medical Medicare Allowed Amount | 58055.14 |
| Total Medical Medicare Payment Amount | 42502.37 |
| Total Medical Medicare Standardized Payment Amount | 45505.56 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 187 |
| Number Of Beneficiaries Age 65 to 74 | 342 |
| Number Of Beneficiaries Age 75 to 84 | 253 |
| Number Of Beneficiaries Age Greater 84 | 137 |
| Number Of Female Beneficiaries | 537 |
| Number Of Male Beneficiaries | 382 |
| Number Of Non Hispanic White Beneficiaries | 805 |
| Number Of Black or African American Beneficiaries | 95 |
| 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 | 616 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 303 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 31 |
| Average HCC Risk Score Of Beneficiaries | 1.9409 |