| National Provider Identifier [NPI]: | 1649233917 |
| Last Name Of The Provider | FORMAN |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2000 MEADE PARKWAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | SUFFOLK |
| Zip Code Of The Provider | 234344259 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 5724 |
| Number Of Medicare Beneficiaries | 1356 |
| Total Submitted Charge Amount | 792188 |
| Total Medicare Allowed Amount | 441322.63 |
| Total Medicare Payment Amount | 331470.43 |
| Total Medicare Standardized Payment Amount | 341453.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 3955 |
| Total Drug Medicare AllowedAmount | 2497.17 |
| Total Drug Medicare PaymentAmount | 2439.07 |
| Total Drug Medicare Standardized Payment Amount | 2439.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 5680 |
| Number Of Medicare Beneficiaries With Medical Services | 1356 |
| Total Medical Submitted Charge Amount | 788233 |
| Total Medical Medicare Allowed Amount | 438825.46 |
| Total Medical Medicare Payment Amount | 329031.36 |
| Total Medical Medicare Standardized Payment Amount | 339014.79 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 173 |
| Number Of Beneficiaries Age 65 to 74 | 568 |
| Number Of Beneficiaries Age 75 to 84 | 447 |
| Number Of Beneficiaries Age Greater 84 | 168 |
| Number Of Female Beneficiaries | 719 |
| Number Of Male Beneficiaries | 637 |
| Number Of Non Hispanic White Beneficiaries | 953 |
| Number Of Black or African American Beneficiaries | 389 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1068 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 288 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 21 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 49 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.8584 |