| National Provider Identifier [NPI]: | 1023089851 |
| Last Name Of The Provider | JENSEN |
| First Name Of The Provider | REGINA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4536 TECHNOLOGY DR |
| Street Address 2 Of The Provider | STE 3 |
| City Of The Provider | WILMINGTON |
| Zip Code Of The Provider | 284052153 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 2996 |
| Number Of Medicare Beneficiaries | 40 |
| Total Submitted Charge Amount | 635281 |
| Total Medicare Allowed Amount | 182006.91 |
| Total Medicare Payment Amount | 145386.91 |
| Total Medicare Standardized Payment Amount | 153119.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 1840 |
| Total Drug Medicare AllowedAmount | 345.9 |
| Total Drug Medicare PaymentAmount | 336.7 |
| Total Drug Medicare Standardized Payment Amount | 336.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 2972 |
| Number Of Medicare Beneficiaries With Medical Services | 40 |
| Total Medical Submitted Charge Amount | 633441 |
| Total Medical Medicare Allowed Amount | 181661.01 |
| Total Medical Medicare Payment Amount | 145050.21 |
| Total Medical Medicare Standardized Payment Amount | 152782.66 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 28 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 28 |
| Number Of Male Beneficiaries | 12 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 55 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 53 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.8266 |