| National Provider Identifier [NPI]: | 1679549836 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | HENRY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4224 HOUMA BLVD |
| Street Address 2 Of The Provider | SUITE 410 |
| City Of The Provider | METAIRIE |
| Zip Code Of The Provider | 700062933 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 734 |
| Number Of Medicare Beneficiaries | 201 |
| Total Submitted Charge Amount | 176950.79 |
| Total Medicare Allowed Amount | 70814.09 |
| Total Medicare Payment Amount | 52613.97 |
| Total Medicare Standardized Payment Amount | 53159.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 936 |
| Total Drug Medicare AllowedAmount | 355.9 |
| Total Drug Medicare PaymentAmount | 348.75 |
| Total Drug Medicare Standardized Payment Amount | 348.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 719 |
| Number Of Medicare Beneficiaries With Medical Services | 201 |
| Total Medical Submitted Charge Amount | 176014.79 |
| Total Medical Medicare Allowed Amount | 70458.19 |
| Total Medical Medicare Payment Amount | 52265.22 |
| Total Medical Medicare Standardized Payment Amount | 52810.29 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 64 |
| Number Of Beneficiaries Age 75 to 84 | 63 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 115 |
| Number Of Male Beneficiaries | 86 |
| Number Of Non Hispanic White Beneficiaries | 159 |
| Number Of Black or African American Beneficiaries | 25 |
| 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 | 161 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 49 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.9153 |