| National Provider Identifier [NPI]: | 1124206487 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | BRADLEY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 300 PASTEUR DR, ROOM H3630, MC: 5642 |
| Street Address 2 Of The Provider | STANFORD UNIVERSITY MED CTR, DEPT. OF INT. RADIOLOGY |
| City Of The Provider | STANFORD |
| Zip Code Of The Provider | 943055642 |
| 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 | 221 |
| Number Of Services | 4246 |
| Number Of Medicare Beneficiaries | 2292 |
| Total Submitted Charge Amount | 779367.75 |
| Total Medicare Allowed Amount | 164216.47 |
| Total Medicare Payment Amount | 126467.44 |
| Total Medicare Standardized Payment Amount | 119138.78 |
| 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 | 221 |
| Number Of Medical Services | 4246 |
| Number Of Medicare Beneficiaries With Medical Services | 2292 |
| Total Medical Submitted Charge Amount | 779367.75 |
| Total Medical Medicare Allowed Amount | 164216.47 |
| Total Medical Medicare Payment Amount | 126467.44 |
| Total Medical Medicare Standardized Payment Amount | 119138.78 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 225 |
| Number Of Beneficiaries Age 65 to 74 | 684 |
| Number Of Beneficiaries Age 75 to 84 | 751 |
| Number Of Beneficiaries Age Greater 84 | 632 |
| Number Of Female Beneficiaries | 1288 |
| Number Of Male Beneficiaries | 1004 |
| Number Of Non Hispanic White Beneficiaries | 1611 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 301 |
| Number Of Hispanic Beneficiaries | 291 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 48 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1682 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 610 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 1.9294 |