| National Provider Identifier [NPI]: | 1710068952 |
| Last Name Of The Provider | JACOBSON |
| First Name Of The Provider | JON |
| 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 | 1500 EAST MEDICAL CENTER DR |
| Street Address 2 Of The Provider | 2ND FLOOR TAUBMAN CTR RECP A |
| City Of The Provider | ANN ARBOR |
| Zip Code Of The Provider | 481095326 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 97 |
| Number Of Services | 2070 |
| Number Of Medicare Beneficiaries | 1390 |
| Total Submitted Charge Amount | 167482 |
| Total Medicare Allowed Amount | 40028.66 |
| Total Medicare Payment Amount | 30112.39 |
| Total Medicare Standardized Payment Amount | 29121.98 |
| 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 | 97 |
| Number Of Medical Services | 2070 |
| Number Of Medicare Beneficiaries With Medical Services | 1390 |
| Total Medical Submitted Charge Amount | 167482 |
| Total Medical Medicare Allowed Amount | 40028.66 |
| Total Medical Medicare Payment Amount | 30112.39 |
| Total Medical Medicare Standardized Payment Amount | 29121.98 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 335 |
| Number Of Beneficiaries Age 65 to 74 | 620 |
| Number Of Beneficiaries Age 75 to 84 | 313 |
| Number Of Beneficiaries Age Greater 84 | 122 |
| Number Of Female Beneficiaries | 821 |
| Number Of Male Beneficiaries | 569 |
| Number Of Non Hispanic White Beneficiaries | 1155 |
| Number Of Black or African American Beneficiaries | 138 |
| Number Of AsianPacific Islander Beneficiaries | 40 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1105 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 285 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.5136 |