| National Provider Identifier [NPI]: | 1780772673 |
| Last Name Of The Provider | HALICKMAN |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3401 PGA BOULEVARD |
| Street Address 2 Of The Provider | SUITE 310 |
| City Of The Provider | PALM BEACH GARDENS |
| Zip Code Of The Provider | 33410 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 5644 |
| Number Of Medicare Beneficiaries | 1111 |
| Total Submitted Charge Amount | 709811.11 |
| Total Medicare Allowed Amount | 441827.15 |
| Total Medicare Payment Amount | 330324.39 |
| Total Medicare Standardized Payment Amount | 316205.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 271 |
| Number Of Medicare Beneficiaries With Drug Services | 229 |
| Total Drug Submitted ChargeAmount | 14020.06 |
| Total Drug Medicare AllowedAmount | 7045.51 |
| Total Drug Medicare PaymentAmount | 6894.51 |
| Total Drug Medicare Standardized Payment Amount | 6894.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 5373 |
| Number Of Medicare Beneficiaries With Medical Services | 1111 |
| Total Medical Submitted Charge Amount | 695791.05 |
| Total Medical Medicare Allowed Amount | 434781.64 |
| Total Medical Medicare Payment Amount | 323429.88 |
| Total Medical Medicare Standardized Payment Amount | 309311.07 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 566 |
| Number Of Beneficiaries Age 75 to 84 | 372 |
| Number Of Beneficiaries Age Greater 84 | 152 |
| Number Of Female Beneficiaries | 563 |
| Number Of Male Beneficiaries | 548 |
| Number Of Non Hispanic White Beneficiaries | 1073 |
| 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 | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0016 |