| National Provider Identifier [NPI]: | 1114119542 |
| Last Name Of The Provider | JACOB |
| First Name Of The Provider | SHUSHAN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 902 W RANDOL MILL RD STE 120 |
| Street Address 2 Of The Provider | |
| City Of The Provider | ARLINGTON |
| Zip Code Of The Provider | 760122579 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hand Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 516 |
| Number Of Medicare Beneficiaries | 129 |
| Total Submitted Charge Amount | 103318.6 |
| Total Medicare Allowed Amount | 40252.82 |
| Total Medicare Payment Amount | 29130.24 |
| Total Medicare Standardized Payment Amount | 31273.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 42 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 1604 |
| Total Drug Medicare AllowedAmount | 123.42 |
| Total Drug Medicare PaymentAmount | 94.81 |
| Total Drug Medicare Standardized Payment Amount | 94.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 474 |
| Number Of Medicare Beneficiaries With Medical Services | 129 |
| Total Medical Submitted Charge Amount | 101714.6 |
| Total Medical Medicare Allowed Amount | 40129.4 |
| Total Medical Medicare Payment Amount | 29035.43 |
| Total Medical Medicare Standardized Payment Amount | 31179.03 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 57 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 77 |
| Number Of Male Beneficiaries | 52 |
| Number Of Non Hispanic White Beneficiaries | 90 |
| Number Of Black or African American Beneficiaries | 20 |
| 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 | 102 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5813 |