| National Provider Identifier [NPI]: | 1639181134 |
| Last Name Of The Provider | KOSTRINSKY |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | D.O |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5525 GROSSMONT CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | LA MESA |
| Zip Code Of The Provider | 919423009 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 202 |
| Number Of Medicare Beneficiaries | 59 |
| Total Submitted Charge Amount | 34407 |
| Total Medicare Allowed Amount | 15094.57 |
| Total Medicare Payment Amount | 10839.54 |
| Total Medicare Standardized Payment Amount | 10478.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 19 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 1743 |
| Total Drug Medicare AllowedAmount | 880.4 |
| Total Drug Medicare PaymentAmount | 859.96 |
| Total Drug Medicare Standardized Payment Amount | 859.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 183 |
| Number Of Medicare Beneficiaries With Medical Services | 59 |
| Total Medical Submitted Charge Amount | 32664 |
| Total Medical Medicare Allowed Amount | 14214.17 |
| Total Medical Medicare Payment Amount | 9979.58 |
| Total Medical Medicare Standardized Payment Amount | 9618.18 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 28 |
| Number Of Beneficiaries Age 75 to 84 | 14 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 47 |
| Number Of Male Beneficiaries | 12 |
| Number Of Non Hispanic White Beneficiaries | 41 |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 46 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.968 |