| National Provider Identifier [NPI]: | 1356394811 |
| Last Name Of The Provider | JACOBSEN |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8881 FLETCHER PARKWAY |
| Street Address 2 Of The Provider | #102 |
| City Of The Provider | LA MESA |
| Zip Code Of The Provider | 91942 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 222 |
| Number Of Services | 2596 |
| Number Of Medicare Beneficiaries | 1477 |
| Total Submitted Charge Amount | 500197 |
| Total Medicare Allowed Amount | 143273.77 |
| Total Medicare Payment Amount | 108087.45 |
| Total Medicare Standardized Payment Amount | 106260.18 |
| 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 | 222 |
| Number Of Medical Services | 2596 |
| Number Of Medicare Beneficiaries With Medical Services | 1477 |
| Total Medical Submitted Charge Amount | 500197 |
| Total Medical Medicare Allowed Amount | 143273.77 |
| Total Medical Medicare Payment Amount | 108087.45 |
| Total Medical Medicare Standardized Payment Amount | 106260.18 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 296 |
| Number Of Beneficiaries Age 65 to 74 | 531 |
| Number Of Beneficiaries Age 75 to 84 | 370 |
| Number Of Beneficiaries Age Greater 84 | 280 |
| Number Of Female Beneficiaries | 812 |
| Number Of Male Beneficiaries | 665 |
| Number Of Non Hispanic White Beneficiaries | 1076 |
| Number Of Black or African American Beneficiaries | 98 |
| Number Of AsianPacific Islander Beneficiaries | 72 |
| Number Of Hispanic Beneficiaries | 176 |
| Number Of American Indian Alaska Native Beneficiaries | 12 |
| Number Of Beneficiaries With Race Not Else where Classified | 43 |
| Number Of Beneficiaries With Medicare Only Entitlement | 795 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 682 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 52 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.3925 |