| National Provider Identifier [NPI]: | 1306894423 |
| Last Name Of The Provider | JACOBSON |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 922 SHORE ACRES DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | LEESBURG |
| Zip Code Of The Provider | 347489269 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 218 |
| Number Of Services | 25525 |
| Number Of Medicare Beneficiaries | 3783 |
| Total Submitted Charge Amount | 2612676.92 |
| Total Medicare Allowed Amount | 1065602.9 |
| Total Medicare Payment Amount | 823194.47 |
| Total Medicare Standardized Payment Amount | 839194.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 17017 |
| Number Of Medicare Beneficiaries With Drug Services | 400 |
| Total Drug Submitted ChargeAmount | 10786.59 |
| Total Drug Medicare AllowedAmount | 6549.81 |
| Total Drug Medicare PaymentAmount | 5126.14 |
| Total Drug Medicare Standardized Payment Amount | 5126.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 211 |
| Number Of Medical Services | 8508 |
| Number Of Medicare Beneficiaries With Medical Services | 3782 |
| Total Medical Submitted Charge Amount | 2601890.33 |
| Total Medical Medicare Allowed Amount | 1059053.09 |
| Total Medical Medicare Payment Amount | 818068.33 |
| Total Medical Medicare Standardized Payment Amount | 834068.04 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 113 |
| Number Of Beneficiaries Age 65 to 74 | 1951 |
| Number Of Beneficiaries Age 75 to 84 | 1405 |
| Number Of Beneficiaries Age Greater 84 | 314 |
| Number Of Female Beneficiaries | 2254 |
| Number Of Male Beneficiaries | 1529 |
| Number Of Non Hispanic White Beneficiaries | 3623 |
| Number Of Black or African American Beneficiaries | 51 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 54 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3697 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 86 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 67 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1683 |