| National Provider Identifier [NPI]: | 1649257163 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1800 HOLLISTER DR |
| Street Address 2 Of The Provider | SUITE G-18 |
| City Of The Provider | LIBERTYVILLE |
| Zip Code Of The Provider | 600485263 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 127 |
| Number Of Services | 4384 |
| Number Of Medicare Beneficiaries | 3641 |
| Total Submitted Charge Amount | 610388 |
| Total Medicare Allowed Amount | 189205.2 |
| Total Medicare Payment Amount | 144975.02 |
| Total Medicare Standardized Payment Amount | 137002.87 |
| 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 | 127 |
| Number Of Medical Services | 4384 |
| Number Of Medicare Beneficiaries With Medical Services | 3641 |
| Total Medical Submitted Charge Amount | 610388 |
| Total Medical Medicare Allowed Amount | 189205.2 |
| Total Medical Medicare Payment Amount | 144975.02 |
| Total Medical Medicare Standardized Payment Amount | 137002.87 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 216 |
| Number Of Beneficiaries Age 65 to 74 | 1481 |
| Number Of Beneficiaries Age 75 to 84 | 1260 |
| Number Of Beneficiaries Age Greater 84 | 684 |
| Number Of Female Beneficiaries | 2455 |
| Number Of Male Beneficiaries | 1186 |
| Number Of Non Hispanic White Beneficiaries | 3117 |
| Number Of Black or African American Beneficiaries | 136 |
| Number Of AsianPacific Islander Beneficiaries | 197 |
| Number Of Hispanic Beneficiaries | 102 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3075 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 566 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4025 |