| National Provider Identifier [NPI]: | 1932106234 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | TERRY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 560 W MITCHELL ST |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | PETOSKEY |
| Zip Code Of The Provider | 497702275 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 92 |
| Number Of Services | 6332 |
| Number Of Medicare Beneficiaries | 778 |
| Total Submitted Charge Amount | 514495 |
| Total Medicare Allowed Amount | 329167.45 |
| Total Medicare Payment Amount | 248749.4 |
| Total Medicare Standardized Payment Amount | 257491.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 202 |
| Number Of Medicare Beneficiaries With Drug Services | 186 |
| Total Drug Submitted ChargeAmount | 5931 |
| Total Drug Medicare AllowedAmount | 4163.88 |
| Total Drug Medicare PaymentAmount | 3947.54 |
| Total Drug Medicare Standardized Payment Amount | 3947.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 83 |
| Number Of Medical Services | 6130 |
| Number Of Medicare Beneficiaries With Medical Services | 778 |
| Total Medical Submitted Charge Amount | 508564 |
| Total Medical Medicare Allowed Amount | 325003.57 |
| Total Medical Medicare Payment Amount | 244801.86 |
| Total Medical Medicare Standardized Payment Amount | 253543.48 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 268 |
| Number Of Beneficiaries Age 75 to 84 | 255 |
| Number Of Beneficiaries Age Greater 84 | 200 |
| Number Of Female Beneficiaries | 375 |
| Number Of Male Beneficiaries | 403 |
| Number Of Non Hispanic White Beneficiaries | 758 |
| 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 | 622 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 156 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.262 |