| National Provider Identifier [NPI]: | 1831256957 |
| Last Name Of The Provider | BURGESS |
| First Name Of The Provider | JERALD |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 19 MEDICAL LOOP |
| Street Address 2 Of The Provider | SUITE #3 |
| City Of The Provider | WHITLEY CITY |
| Zip Code Of The Provider | 426534382 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 1483 |
| Number Of Medicare Beneficiaries | 246 |
| Total Submitted Charge Amount | 49051 |
| Total Medicare Allowed Amount | 13323.24 |
| Total Medicare Payment Amount | 11310.06 |
| Total Medicare Standardized Payment Amount | 11973.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 300 |
| Number Of Medicare Beneficiaries With Drug Services | 79 |
| Total Drug Submitted ChargeAmount | 4010 |
| Total Drug Medicare AllowedAmount | 770.52 |
| Total Drug Medicare PaymentAmount | 431.44 |
| Total Drug Medicare Standardized Payment Amount | 431.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 1183 |
| Number Of Medicare Beneficiaries With Medical Services | 216 |
| Total Medical Submitted Charge Amount | 45041 |
| Total Medical Medicare Allowed Amount | 12552.72 |
| Total Medical Medicare Payment Amount | 10878.62 |
| Total Medical Medicare Standardized Payment Amount | 11542.12 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 90 |
| Number Of Beneficiaries Age 65 to 74 | 89 |
| Number Of Beneficiaries Age 75 to 84 | 55 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 129 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 97 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 149 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3783 |