| National Provider Identifier [NPI]: | 1235136052 |
| Last Name Of The Provider | JENSEN |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1107 MEMORIAL DR |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | DALTON |
| Zip Code Of The Provider | 307208662 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 114 |
| Number Of Services | 12091 |
| Number Of Medicare Beneficiaries | 1552 |
| Total Submitted Charge Amount | 772255 |
| Total Medicare Allowed Amount | 416995 |
| Total Medicare Payment Amount | 305073.33 |
| Total Medicare Standardized Payment Amount | 307930.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 1868 |
| Number Of Medicare Beneficiaries With Drug Services | 233 |
| Total Drug Submitted ChargeAmount | 44255 |
| Total Drug Medicare AllowedAmount | 19414.89 |
| Total Drug Medicare PaymentAmount | 16078.55 |
| Total Drug Medicare Standardized Payment Amount | 16078.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 99 |
| Number Of Medical Services | 10223 |
| Number Of Medicare Beneficiaries With Medical Services | 1552 |
| Total Medical Submitted Charge Amount | 728000 |
| Total Medical Medicare Allowed Amount | 397580.11 |
| Total Medical Medicare Payment Amount | 288994.78 |
| Total Medical Medicare Standardized Payment Amount | 291852.06 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 284 |
| Number Of Beneficiaries Age 65 to 74 | 523 |
| Number Of Beneficiaries Age 75 to 84 | 491 |
| Number Of Beneficiaries Age Greater 84 | 254 |
| Number Of Female Beneficiaries | 854 |
| Number Of Male Beneficiaries | 698 |
| Number Of Non Hispanic White Beneficiaries | 1453 |
| Number Of Black or African American Beneficiaries | 53 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1138 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 414 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4427 |