| National Provider Identifier [NPI]: | 1730369018 |
| Last Name Of The Provider | JACOBS |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1809 W LOOP 281 |
| Street Address 2 Of The Provider | |
| City Of The Provider | LONGVIEW |
| Zip Code Of The Provider | 756042571 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 1352 |
| Number Of Medicare Beneficiaries | 538 |
| Total Submitted Charge Amount | 115871.7 |
| Total Medicare Allowed Amount | 48444.39 |
| Total Medicare Payment Amount | 31517.01 |
| Total Medicare Standardized Payment Amount | 42606.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 240 |
| Number Of Medicare Beneficiaries With Drug Services | 76 |
| Total Drug Submitted ChargeAmount | 2222 |
| Total Drug Medicare AllowedAmount | 887.16 |
| Total Drug Medicare PaymentAmount | 851.91 |
| Total Drug Medicare Standardized Payment Amount | 851.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 1112 |
| Number Of Medicare Beneficiaries With Medical Services | 538 |
| Total Medical Submitted Charge Amount | 113649.7 |
| Total Medical Medicare Allowed Amount | 47557.23 |
| Total Medical Medicare Payment Amount | 30665.1 |
| Total Medical Medicare Standardized Payment Amount | 41754.28 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 236 |
| Number Of Beneficiaries Age 75 to 84 | 158 |
| Number Of Beneficiaries Age Greater 84 | 64 |
| Number Of Female Beneficiaries | 319 |
| Number Of Male Beneficiaries | 219 |
| Number Of Non Hispanic White Beneficiaries | 520 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 460 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 78 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8214 |