| National Provider Identifier [NPI]: | 1245262054 |
| Last Name Of The Provider | JACOB |
| First Name Of The Provider | DENNIS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1400 N RITTER AVE |
| Street Address 2 Of The Provider | SUITE 500 |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462193052 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Vascular Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 153 |
| Number Of Services | 2879 |
| Number Of Medicare Beneficiaries | 1509 |
| Total Submitted Charge Amount | 1581800.74 |
| Total Medicare Allowed Amount | 485666.93 |
| Total Medicare Payment Amount | 366247.36 |
| Total Medicare Standardized Payment Amount | 395719.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 153 |
| Number Of Medical Services | 2879 |
| Number Of Medicare Beneficiaries With Medical Services | 1509 |
| Total Medical Submitted Charge Amount | 1581800.74 |
| Total Medical Medicare Allowed Amount | 485666.93 |
| Total Medical Medicare Payment Amount | 366247.36 |
| Total Medical Medicare Standardized Payment Amount | 395719.91 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 274 |
| Number Of Beneficiaries Age 65 to 74 | 525 |
| Number Of Beneficiaries Age 75 to 84 | 526 |
| Number Of Beneficiaries Age Greater 84 | 184 |
| Number Of Female Beneficiaries | 759 |
| Number Of Male Beneficiaries | 750 |
| Number Of Non Hispanic White Beneficiaries | 1286 |
| Number Of Black or African American Beneficiaries | 188 |
| 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 | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1170 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 339 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.6559 |