| National Provider Identifier [NPI]: | 1710977145 |
| Last Name Of The Provider | HENNESSEE |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1339 E COURT ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SEGUIN |
| Zip Code Of The Provider | 781555130 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Otolaryngology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 2071 |
| Number Of Medicare Beneficiaries | 680 |
| Total Submitted Charge Amount | 467135.61 |
| Total Medicare Allowed Amount | 198515.71 |
| Total Medicare Payment Amount | 146627.14 |
| Total Medicare Standardized Payment Amount | 151971.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 107 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 141.61 |
| Total Drug Medicare AllowedAmount | 32.82 |
| Total Drug Medicare PaymentAmount | 25.73 |
| Total Drug Medicare Standardized Payment Amount | 25.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 89 |
| Number Of Medical Services | 1964 |
| Number Of Medicare Beneficiaries With Medical Services | 680 |
| Total Medical Submitted Charge Amount | 466994 |
| Total Medical Medicare Allowed Amount | 198482.89 |
| Total Medical Medicare Payment Amount | 146601.41 |
| Total Medical Medicare Standardized Payment Amount | 151946.12 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 88 |
| Number Of Beneficiaries Age 65 to 74 | 264 |
| Number Of Beneficiaries Age 75 to 84 | 214 |
| Number Of Beneficiaries Age Greater 84 | 114 |
| Number Of Female Beneficiaries | 381 |
| Number Of Male Beneficiaries | 299 |
| Number Of Non Hispanic White Beneficiaries | 519 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 118 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 539 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 141 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3365 |