| National Provider Identifier [NPI]: | 1245237007 |
| Last Name Of The Provider | JACOB |
| First Name Of The Provider | MOSHIR |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4235 SECOR RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TOLEDO |
| Zip Code Of The Provider | 436234231 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 6204 |
| Number Of Medicare Beneficiaries | 525 |
| Total Submitted Charge Amount | 487679.77 |
| Total Medicare Allowed Amount | 303491.67 |
| Total Medicare Payment Amount | 228187.56 |
| Total Medicare Standardized Payment Amount | 226333.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 2714 |
| Number Of Medicare Beneficiaries With Drug Services | 168 |
| Total Drug Submitted ChargeAmount | 56986.98 |
| Total Drug Medicare AllowedAmount | 27033.67 |
| Total Drug Medicare PaymentAmount | 21875.88 |
| Total Drug Medicare Standardized Payment Amount | 21875.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 3490 |
| Number Of Medicare Beneficiaries With Medical Services | 525 |
| Total Medical Submitted Charge Amount | 430692.79 |
| Total Medical Medicare Allowed Amount | 276458 |
| Total Medical Medicare Payment Amount | 206311.68 |
| Total Medical Medicare Standardized Payment Amount | 204457.4 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 91 |
| Number Of Beneficiaries Age 65 to 74 | 183 |
| Number Of Beneficiaries Age 75 to 84 | 174 |
| Number Of Beneficiaries Age Greater 84 | 77 |
| Number Of Female Beneficiaries | 249 |
| Number Of Male Beneficiaries | 276 |
| Number Of Non Hispanic White Beneficiaries | 446 |
| Number Of Black or African American Beneficiaries | 54 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 434 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 91 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 59 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 1.8558 |