National Provider Identifier [NPI]: |
1417976739 |
Last Name Of The Provider |
BRYAN |
First Name Of The Provider |
JENNIFER |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2500 N STATE ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
JACKSON |
Zip Code Of The Provider |
392164500 |
State Code Of The Provider |
MS |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
41 |
Number Of Services |
1228 |
Number Of Medicare Beneficiaries |
248 |
Total Submitted Charge Amount |
135024 |
Total Medicare Allowed Amount |
70320.21 |
Total Medicare Payment Amount |
48533.18 |
Total Medicare Standardized Payment Amount |
53108.8 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
10 |
Number Of Drug Services |
166 |
Number Of Medicare Beneficiaries With Drug Services |
85 |
Total Drug Submitted ChargeAmount |
5606 |
Total Drug Medicare AllowedAmount |
2946.33 |
Total Drug Medicare PaymentAmount |
2864.85 |
Total Drug Medicare Standardized Payment Amount |
2864.85 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
31 |
Number Of Medical Services |
1062 |
Number Of Medicare Beneficiaries With Medical Services |
248 |
Total Medical Submitted Charge Amount |
129418 |
Total Medical Medicare Allowed Amount |
67373.88 |
Total Medical Medicare Payment Amount |
45668.33 |
Total Medical Medicare Standardized Payment Amount |
50243.95 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
57 |
Number Of Beneficiaries Age 65 to 74 |
122 |
Number Of Beneficiaries Age 75 to 84 |
52 |
Number Of Beneficiaries Age Greater 84 |
17 |
Number Of Female Beneficiaries |
154 |
Number Of Male Beneficiaries |
94 |
Number Of Non Hispanic White Beneficiaries |
167 |
Number Of Black or African American Beneficiaries |
|
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 |
182 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
66 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
16 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
18 |
Percent Of With Depression |
29 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
44 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
28 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.1971 |