| National Provider Identifier [NPI]: | 1821112301 |
| Last Name Of The Provider | ROBERTS |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1221 PINE GROVE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT HURON |
| Zip Code Of The Provider | 480603511 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 102 |
| Number Of Services | 898 |
| Number Of Medicare Beneficiaries | 752 |
| Total Submitted Charge Amount | 969914 |
| Total Medicare Allowed Amount | 105020.25 |
| Total Medicare Payment Amount | 81233.56 |
| Total Medicare Standardized Payment Amount | 80959.61 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
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| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 173 |
| Number Of Beneficiaries Age 65 to 74 | 324 |
| Number Of Beneficiaries Age 75 to 84 | 189 |
| Number Of Beneficiaries Age Greater 84 | 66 |
| Number Of Female Beneficiaries | 425 |
| Number Of Male Beneficiaries | 327 |
| Number Of Non Hispanic White Beneficiaries | 613 |
| Number Of Black or African American Beneficiaries | 107 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 532 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 220 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.9075 |