| National Provider Identifier [NPI]: | 1164411013 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1900 PINE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ABILENE |
| Zip Code Of The Provider | 796012432 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 137 |
| Number Of Services | 13161 |
| Number Of Medicare Beneficiaries | 1663 |
| Total Submitted Charge Amount | 693711.01 |
| Total Medicare Allowed Amount | 376061.76 |
| Total Medicare Payment Amount | 263308.95 |
| Total Medicare Standardized Payment Amount | 266248.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 30 |
| Number Of Drug Services | 5098 |
| Number Of Medicare Beneficiaries With Drug Services | 916 |
| Total Drug Submitted ChargeAmount | 67680 |
| Total Drug Medicare AllowedAmount | 7277.75 |
| Total Drug Medicare PaymentAmount | 5454.27 |
| Total Drug Medicare Standardized Payment Amount | 5454.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 107 |
| Number Of Medical Services | 8063 |
| Number Of Medicare Beneficiaries With Medical Services | 1662 |
| Total Medical Submitted Charge Amount | 626031.01 |
| Total Medical Medicare Allowed Amount | 368784.01 |
| Total Medical Medicare Payment Amount | 257854.68 |
| Total Medical Medicare Standardized Payment Amount | 260794.45 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 172 |
| Number Of Beneficiaries Age 65 to 74 | 781 |
| Number Of Beneficiaries Age 75 to 84 | 521 |
| Number Of Beneficiaries Age Greater 84 | 189 |
| Number Of Female Beneficiaries | 992 |
| Number Of Male Beneficiaries | 671 |
| Number Of Non Hispanic White Beneficiaries | 1509 |
| Number Of Black or African American Beneficiaries | 37 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 90 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1567 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 96 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9234 |