| National Provider Identifier [NPI]: | 1447283296 |
| Last Name Of The Provider | HALSTEAD |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 501 S 54TH ST |
| Street Address 2 Of The Provider | ACADEMIC ER SVCS - ER DEPT. |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191431900 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 339 |
| Number Of Medicare Beneficiaries | 295 |
| Total Submitted Charge Amount | 120518 |
| Total Medicare Allowed Amount | 49010.36 |
| Total Medicare Payment Amount | 36592.29 |
| Total Medicare Standardized Payment Amount | 34705.9 |
| 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 | 22 |
| Number Of Medical Services | 339 |
| Number Of Medicare Beneficiaries With Medical Services | 295 |
| Total Medical Submitted Charge Amount | 120518 |
| Total Medical Medicare Allowed Amount | 49010.36 |
| Total Medical Medicare Payment Amount | 36592.29 |
| Total Medical Medicare Standardized Payment Amount | 34705.9 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 140 |
| Number Of Beneficiaries Age 65 to 74 | 78 |
| Number Of Beneficiaries Age 75 to 84 | 34 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 177 |
| Number Of Male Beneficiaries | 118 |
| Number Of Non Hispanic White Beneficiaries | 85 |
| Number Of Black or African American Beneficiaries | 197 |
| 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 | 110 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 185 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 22 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 21 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.15 |