| National Provider Identifier [NPI]: | 1295879518 |
| Last Name Of The Provider | JACOBY |
| First Name Of The Provider | WENDY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9 WASHINGTON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAMDEN |
| Zip Code Of The Provider | 065183267 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 2018 |
| Number Of Medicare Beneficiaries | 665 |
| Total Submitted Charge Amount | 188575 |
| Total Medicare Allowed Amount | 138279.18 |
| Total Medicare Payment Amount | 99840.93 |
| Total Medicare Standardized Payment Amount | 94349.82 |
| 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 | 24 |
| Number Of Medical Services | 2018 |
| Number Of Medicare Beneficiaries With Medical Services | 665 |
| Total Medical Submitted Charge Amount | 188575 |
| Total Medical Medicare Allowed Amount | 138279.18 |
| Total Medical Medicare Payment Amount | 99840.93 |
| Total Medical Medicare Standardized Payment Amount | 94349.82 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 338 |
| Number Of Beneficiaries Age 75 to 84 | 197 |
| Number Of Beneficiaries Age Greater 84 | 98 |
| Number Of Female Beneficiaries | 468 |
| Number Of Male Beneficiaries | 197 |
| Number Of Non Hispanic White Beneficiaries | 609 |
| Number Of Black or African American Beneficiaries | 18 |
| 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 | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 593 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 72 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9559 |