| National Provider Identifier [NPI]: | 1962400135 |
| Last Name Of The Provider | JACOBSON |
| First Name Of The Provider | RANDALL |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 427 S BERNARD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPOKANE |
| Zip Code Of The Provider | 992042509 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 2626 |
| Number Of Medicare Beneficiaries | 1039 |
| Total Submitted Charge Amount | 831279 |
| Total Medicare Allowed Amount | 444569.41 |
| Total Medicare Payment Amount | 324302.7 |
| Total Medicare Standardized Payment Amount | 329251.44 |
| 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 | 43 |
| Number Of Medical Services | 2626 |
| Number Of Medicare Beneficiaries With Medical Services | 1039 |
| Total Medical Submitted Charge Amount | 831279 |
| Total Medical Medicare Allowed Amount | 444569.41 |
| Total Medical Medicare Payment Amount | 324302.7 |
| Total Medical Medicare Standardized Payment Amount | 329251.44 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 384 |
| Number Of Beneficiaries Age 75 to 84 | 443 |
| Number Of Beneficiaries Age Greater 84 | 165 |
| Number Of Female Beneficiaries | 609 |
| Number Of Male Beneficiaries | 430 |
| Number Of Non Hispanic White Beneficiaries | 998 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 971 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0086 |