| National Provider Identifier [NPI]: | 1689639577 |
| Last Name Of The Provider | FISHENFELD |
| First Name Of The Provider | JACO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 150 N JACKSON AVENUE |
| Street Address 2 Of The Provider | SUITE 105 |
| City Of The Provider | SAN JOSE |
| Zip Code Of The Provider | 951161907 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 1705 |
| Number Of Medicare Beneficiaries | 336 |
| Total Submitted Charge Amount | 167858 |
| Total Medicare Allowed Amount | 155931.1 |
| Total Medicare Payment Amount | 113423.13 |
| Total Medicare Standardized Payment Amount | 100480.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 203 |
| Number Of Medicare Beneficiaries With Drug Services | 188 |
| Total Drug Submitted ChargeAmount | 6720 |
| Total Drug Medicare AllowedAmount | 3948.7 |
| Total Drug Medicare PaymentAmount | 3869.36 |
| Total Drug Medicare Standardized Payment Amount | 3869.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 1502 |
| Number Of Medicare Beneficiaries With Medical Services | 336 |
| Total Medical Submitted Charge Amount | 161138 |
| Total Medical Medicare Allowed Amount | 151982.4 |
| Total Medical Medicare Payment Amount | 109553.77 |
| Total Medical Medicare Standardized Payment Amount | 96610.68 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 156 |
| Number Of Beneficiaries Age 75 to 84 | 119 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 190 |
| Number Of Male Beneficiaries | 146 |
| Number Of Non Hispanic White Beneficiaries | 153 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | 50 |
| Number Of Hispanic Beneficiaries | 91 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 294 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 75 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9234 |