| National Provider Identifier [NPI]: | 1104878875 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | JEANETTE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 18589 N 59TH AVE |
| Street Address 2 Of The Provider | STE. 101 |
| City Of The Provider | GLENDALE |
| Zip Code Of The Provider | 853081258 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 260 |
| Number Of Medicare Beneficiaries | 135 |
| Total Submitted Charge Amount | 27809.25 |
| Total Medicare Allowed Amount | 16190.78 |
| Total Medicare Payment Amount | 11127.44 |
| Total Medicare Standardized Payment Amount | 11381.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 40 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 589.25 |
| Total Drug Medicare AllowedAmount | 79.51 |
| Total Drug Medicare PaymentAmount | 62.34 |
| Total Drug Medicare Standardized Payment Amount | 62.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 220 |
| Number Of Medicare Beneficiaries With Medical Services | 135 |
| Total Medical Submitted Charge Amount | 27220 |
| Total Medical Medicare Allowed Amount | 16111.27 |
| Total Medical Medicare Payment Amount | 11065.1 |
| Total Medical Medicare Standardized Payment Amount | 11319.08 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | 34 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 89 |
| Number Of Male Beneficiaries | 46 |
| Number Of Non Hispanic White Beneficiaries | 112 |
| 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 | 113 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8671 |