| National Provider Identifier [NPI]: | 1477550176 |
| Last Name Of The Provider | SMALL |
| First Name Of The Provider | JACOB |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PHD, ARNP-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 372 W 47TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | HIALEAH |
| Zip Code Of The Provider | 330123950 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 2418 |
| Number Of Medicare Beneficiaries | 374 |
| Total Submitted Charge Amount | 150049.33 |
| Total Medicare Allowed Amount | 146617.35 |
| Total Medicare Payment Amount | 113002.63 |
| Total Medicare Standardized Payment Amount | 121254.46 |
| 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 | 22 |
| Number Of Medical Services | 2418 |
| Number Of Medicare Beneficiaries With Medical Services | 374 |
| Total Medical Submitted Charge Amount | 150049.33 |
| Total Medical Medicare Allowed Amount | 146617.35 |
| Total Medical Medicare Payment Amount | 113002.63 |
| Total Medical Medicare Standardized Payment Amount | 121254.46 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 75 |
| Number Of Beneficiaries Age 75 to 84 | 131 |
| Number Of Beneficiaries Age Greater 84 | 133 |
| Number Of Female Beneficiaries | 230 |
| Number Of Male Beneficiaries | 144 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 349 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 18 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 356 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 64 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 67 |
| Percent Of With Chronic Kidney Disease | 59 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 62 |
| Percent Of With Depression | 58 |
| Percent Of With Diabetes | 70 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 23 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.9838 |