| National Provider Identifier [NPI]: | 1427019454 |
| Last Name Of The Provider | FORD |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2142 N COVE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TOLEDO |
| Zip Code Of The Provider | 436063895 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 835 |
| Number Of Medicare Beneficiaries | 551 |
| Total Submitted Charge Amount | 273065.16 |
| Total Medicare Allowed Amount | 89634.45 |
| Total Medicare Payment Amount | 68759.33 |
| Total Medicare Standardized Payment Amount | 69251.78 |
| 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 | 21 |
| Number Of Medical Services | 835 |
| Number Of Medicare Beneficiaries With Medical Services | 551 |
| Total Medical Submitted Charge Amount | 273065.16 |
| Total Medical Medicare Allowed Amount | 89634.45 |
| Total Medical Medicare Payment Amount | 68759.33 |
| Total Medical Medicare Standardized Payment Amount | 69251.78 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 192 |
| Number Of Beneficiaries Age 65 to 74 | 136 |
| Number Of Beneficiaries Age 75 to 84 | 130 |
| Number Of Beneficiaries Age Greater 84 | 93 |
| Number Of Female Beneficiaries | 307 |
| Number Of Male Beneficiaries | 244 |
| Number Of Non Hispanic White Beneficiaries | 437 |
| Number Of Black or African American Beneficiaries | 94 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 327 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 224 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.9407 |