| National Provider Identifier [NPI]: | 1861621609 |
| Last Name Of The Provider | JEPSON |
| First Name Of The Provider | TIFFANI |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6770 CINCINNATI DAYTON RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LIBERTY TOWNSHIP |
| Zip Code Of The Provider | 450449318 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 641 |
| Number Of Medicare Beneficiaries | 233 |
| Total Submitted Charge Amount | 67164 |
| Total Medicare Allowed Amount | 43315.6 |
| Total Medicare Payment Amount | 30214.79 |
| Total Medicare Standardized Payment Amount | 31420.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 46 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 4336 |
| Total Drug Medicare AllowedAmount | 2709.23 |
| Total Drug Medicare PaymentAmount | 2635.55 |
| Total Drug Medicare Standardized Payment Amount | 2635.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 595 |
| Number Of Medicare Beneficiaries With Medical Services | 233 |
| Total Medical Submitted Charge Amount | 62828 |
| Total Medical Medicare Allowed Amount | 40606.37 |
| Total Medical Medicare Payment Amount | 27579.24 |
| Total Medical Medicare Standardized Payment Amount | 28785.11 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 112 |
| Number Of Beneficiaries Age 75 to 84 | 69 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 148 |
| Number Of Male Beneficiaries | 85 |
| Number Of Non Hispanic White Beneficiaries | 196 |
| Number Of Black or African American Beneficiaries | 26 |
| 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 | 216 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9879 |