| National Provider Identifier [NPI]: | 1760464168 |
| Last Name Of The Provider | GLENN |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 146 SW ORTHOPEDIC CT |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKE CITY |
| Zip Code Of The Provider | 320240672 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 118 |
| Number Of Services | 2847 |
| Number Of Medicare Beneficiaries | 515 |
| Total Submitted Charge Amount | 1129065.89 |
| Total Medicare Allowed Amount | 323358.46 |
| Total Medicare Payment Amount | 244174.2 |
| Total Medicare Standardized Payment Amount | 246988.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 320 |
| Number Of Medicare Beneficiaries With Drug Services | 215 |
| Total Drug Submitted ChargeAmount | 18527.8 |
| Total Drug Medicare AllowedAmount | 6337.03 |
| Total Drug Medicare PaymentAmount | 4882.38 |
| Total Drug Medicare Standardized Payment Amount | 4882.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 113 |
| Number Of Medical Services | 2527 |
| Number Of Medicare Beneficiaries With Medical Services | 515 |
| Total Medical Submitted Charge Amount | 1110538.09 |
| Total Medical Medicare Allowed Amount | 317021.43 |
| Total Medical Medicare Payment Amount | 239291.82 |
| Total Medical Medicare Standardized Payment Amount | 242106.1 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 90 |
| Number Of Beneficiaries Age 65 to 74 | 203 |
| Number Of Beneficiaries Age 75 to 84 | 165 |
| Number Of Beneficiaries Age Greater 84 | 57 |
| Number Of Female Beneficiaries | 345 |
| Number Of Male Beneficiaries | 170 |
| Number Of Non Hispanic White Beneficiaries | 457 |
| Number Of Black or African American Beneficiaries | 45 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 369 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 146 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 73 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3311 |