| National Provider Identifier [NPI]: | 1841580180 |
| Last Name Of The Provider | GEORGIA |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2300 HAGGERTY RD |
| Street Address 2 Of The Provider | STE 1110 |
| City Of The Provider | WEST BLOOMFIELD |
| Zip Code Of The Provider | 48323 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 216 |
| Number Of Medicare Beneficiaries | 74 |
| Total Submitted Charge Amount | 104843 |
| Total Medicare Allowed Amount | 14408.6 |
| Total Medicare Payment Amount | 10206.65 |
| Total Medicare Standardized Payment Amount | 11298.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 56 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 12102 |
| Total Drug Medicare AllowedAmount | 2722.19 |
| Total Drug Medicare PaymentAmount | 2007.85 |
| Total Drug Medicare Standardized Payment Amount | 2007.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 160 |
| Number Of Medicare Beneficiaries With Medical Services | 74 |
| Total Medical Submitted Charge Amount | 92741 |
| Total Medical Medicare Allowed Amount | 11686.41 |
| Total Medical Medicare Payment Amount | 8198.8 |
| Total Medical Medicare Standardized Payment Amount | 9290.97 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 28 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 54 |
| Number Of Male Beneficiaries | 20 |
| Number Of Non Hispanic White Beneficiaries | 36 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 19 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 55 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2417 |