| National Provider Identifier [NPI]: | 1326091547 |
| Last Name Of The Provider | HAVEN |
| First Name Of The Provider | JESSE |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 870 111TH AVE N |
| Street Address 2 Of The Provider | # 9-10 |
| City Of The Provider | NAPLES |
| Zip Code Of The Provider | 341081869 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 7094 |
| Number Of Medicare Beneficiaries | 517 |
| Total Submitted Charge Amount | 394415 |
| Total Medicare Allowed Amount | 192243.19 |
| Total Medicare Payment Amount | 141344.46 |
| Total Medicare Standardized Payment Amount | 136606.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 4814 |
| Number Of Medicare Beneficiaries With Drug Services | 184 |
| Total Drug Submitted ChargeAmount | 22143 |
| Total Drug Medicare AllowedAmount | 13499.08 |
| Total Drug Medicare PaymentAmount | 12795.32 |
| Total Drug Medicare Standardized Payment Amount | 12795.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 78 |
| Number Of Medical Services | 2280 |
| Number Of Medicare Beneficiaries With Medical Services | 515 |
| Total Medical Submitted Charge Amount | 372272 |
| Total Medical Medicare Allowed Amount | 178744.11 |
| Total Medical Medicare Payment Amount | 128549.14 |
| Total Medical Medicare Standardized Payment Amount | 123811.41 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 320 |
| Number Of Beneficiaries Age 75 to 84 | 140 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 257 |
| Number Of Male Beneficiaries | 260 |
| Number Of Non Hispanic White Beneficiaries | 483 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 506 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8874 |