| National Provider Identifier [NPI]: | 1770506297 |
| Last Name Of The Provider | MEDELLIN |
| First Name Of The Provider | JESSE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 BROOKLYN AVE |
| Street Address 2 Of The Provider | SUITE #115 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782124803 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 171 |
| Number Of Services | 71169 |
| Number Of Medicare Beneficiaries | 456 |
| Total Submitted Charge Amount | 4564486 |
| Total Medicare Allowed Amount | 1277237.65 |
| Total Medicare Payment Amount | 999809.73 |
| Total Medicare Standardized Payment Amount | 1019574.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 73 |
| Number Of Drug Services | 60014 |
| Number Of Medicare Beneficiaries With Drug Services | 158 |
| Total Drug Submitted ChargeAmount | 3049724 |
| Total Drug Medicare AllowedAmount | 892945.05 |
| Total Drug Medicare PaymentAmount | 694817.66 |
| Total Drug Medicare Standardized Payment Amount | 694817.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 98 |
| Number Of Medical Services | 11155 |
| Number Of Medicare Beneficiaries With Medical Services | 456 |
| Total Medical Submitted Charge Amount | 1514762 |
| Total Medical Medicare Allowed Amount | 384292.6 |
| Total Medical Medicare Payment Amount | 304992.07 |
| Total Medical Medicare Standardized Payment Amount | 324756.53 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 175 |
| Number Of Beneficiaries Age 75 to 84 | 163 |
| Number Of Beneficiaries Age Greater 84 | 50 |
| Number Of Female Beneficiaries | 282 |
| Number Of Male Beneficiaries | 174 |
| Number Of Non Hispanic White Beneficiaries | 163 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 263 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 321 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 135 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 46 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 2.2147 |