| National Provider Identifier [NPI]: | 1780703900 |
| Last Name Of The Provider | JANSEN |
| First Name Of The Provider | JEREMIAH |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3330 NW 56TH |
| Street Address 2 Of The Provider | SUITE 206 |
| City Of The Provider | OKLA CITY |
| Zip Code Of The Provider | 731124426 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 182 |
| Number Of Services | 8972 |
| Number Of Medicare Beneficiaries | 3747 |
| Total Submitted Charge Amount | 302618.01 |
| Total Medicare Allowed Amount | 283696.08 |
| Total Medicare Payment Amount | 211009 |
| Total Medicare Standardized Payment Amount | 222729.45 |
| 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 | 182 |
| Number Of Medical Services | 8972 |
| Number Of Medicare Beneficiaries With Medical Services | 3747 |
| Total Medical Submitted Charge Amount | 302618.01 |
| Total Medical Medicare Allowed Amount | 283696.08 |
| Total Medical Medicare Payment Amount | 211009 |
| Total Medical Medicare Standardized Payment Amount | 222729.45 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 839 |
| Number Of Beneficiaries Age 65 to 74 | 1410 |
| Number Of Beneficiaries Age 75 to 84 | 1016 |
| Number Of Beneficiaries Age Greater 84 | 482 |
| Number Of Female Beneficiaries | 2246 |
| Number Of Male Beneficiaries | 1501 |
| Number Of Non Hispanic White Beneficiaries | 3204 |
| Number Of Black or African American Beneficiaries | 81 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | 403 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2553 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1194 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5052 |