| National Provider Identifier [NPI]: | 1285622175 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | LEON |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 118 E HASKELL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WINNEMUCCA |
| Zip Code Of The Provider | 894453247 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Radiation Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 184 |
| Number Of Services | 6562 |
| Number Of Medicare Beneficiaries | 3043 |
| Total Submitted Charge Amount | 986463 |
| Total Medicare Allowed Amount | 189958.08 |
| Total Medicare Payment Amount | 146055.85 |
| Total Medicare Standardized Payment Amount | 148065.99 |
| 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 | 184 |
| Number Of Medical Services | 6562 |
| Number Of Medicare Beneficiaries With Medical Services | 3043 |
| Total Medical Submitted Charge Amount | 986463 |
| Total Medical Medicare Allowed Amount | 189958.08 |
| Total Medical Medicare Payment Amount | 146055.85 |
| Total Medical Medicare Standardized Payment Amount | 148065.99 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 540 |
| Number Of Beneficiaries Age 65 to 74 | 1267 |
| Number Of Beneficiaries Age 75 to 84 | 843 |
| Number Of Beneficiaries Age Greater 84 | 393 |
| Number Of Female Beneficiaries | 1821 |
| Number Of Male Beneficiaries | 1222 |
| Number Of Non Hispanic White Beneficiaries | 2722 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 158 |
| Number Of American Indian Alaska Native Beneficiaries | 108 |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2310 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 733 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.133 |