| National Provider Identifier [NPI]: | 1922059609 |
| Last Name Of The Provider | JUSTICE |
| First Name Of The Provider | JACKIE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1907 W MORRIS BLVD |
| Street Address 2 Of The Provider | SUITE G |
| City Of The Provider | MORRISTOWN |
| Zip Code Of The Provider | 378133860 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 3435 |
| Number Of Medicare Beneficiaries | 481 |
| Total Submitted Charge Amount | 306957 |
| Total Medicare Allowed Amount | 122521.04 |
| Total Medicare Payment Amount | 85876.4 |
| Total Medicare Standardized Payment Amount | 106411.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 387 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 14180 |
| Total Drug Medicare AllowedAmount | 6742.64 |
| Total Drug Medicare PaymentAmount | 5250.59 |
| Total Drug Medicare Standardized Payment Amount | 5250.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 3048 |
| Number Of Medicare Beneficiaries With Medical Services | 481 |
| Total Medical Submitted Charge Amount | 292777 |
| Total Medical Medicare Allowed Amount | 115778.4 |
| Total Medical Medicare Payment Amount | 80625.81 |
| Total Medical Medicare Standardized Payment Amount | 101161.19 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 248 |
| Number Of Beneficiaries Age 75 to 84 | 129 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 259 |
| Number Of Male Beneficiaries | 222 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 370 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 111 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0353 |