| National Provider Identifier [NPI]: | 1073574539 |
| Last Name Of The Provider | JACOBS |
| First Name Of The Provider | STUART |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5345 N EL DORADO ST |
| Street Address 2 Of The Provider | STE 12 |
| City Of The Provider | STOCKTON |
| Zip Code Of The Provider | 952075872 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 103 |
| Number Of Services | 30252 |
| Number Of Medicare Beneficiaries | 1788 |
| Total Submitted Charge Amount | 2936475 |
| Total Medicare Allowed Amount | 1708386.96 |
| Total Medicare Payment Amount | 1314865.1 |
| Total Medicare Standardized Payment Amount | 1277494.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 2742 |
| Number Of Medicare Beneficiaries With Drug Services | 279 |
| Total Drug Submitted ChargeAmount | 161825 |
| Total Drug Medicare AllowedAmount | 124890.8 |
| Total Drug Medicare PaymentAmount | 97758.18 |
| Total Drug Medicare Standardized Payment Amount | 97758.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 99 |
| Number Of Medical Services | 27510 |
| Number Of Medicare Beneficiaries With Medical Services | 1788 |
| Total Medical Submitted Charge Amount | 2774650 |
| Total Medical Medicare Allowed Amount | 1583496.16 |
| Total Medical Medicare Payment Amount | 1217106.92 |
| Total Medical Medicare Standardized Payment Amount | 1179735.89 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 66 |
| Number Of Beneficiaries Age 65 to 74 | 863 |
| Number Of Beneficiaries Age 75 to 84 | 576 |
| Number Of Beneficiaries Age Greater 84 | 283 |
| Number Of Female Beneficiaries | 941 |
| Number Of Male Beneficiaries | 847 |
| Number Of Non Hispanic White Beneficiaries | 1623 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 33 |
| Number Of Hispanic Beneficiaries | 92 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1725 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 63 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8855 |