| National Provider Identifier [NPI]: | 1275574295 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | LARRY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2660 10TH AVE S |
| Street Address 2 Of The Provider | SUITE 528 |
| City Of The Provider | BIRMINGHAM |
| Zip Code Of The Provider | 352051605 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 1817 |
| Number Of Medicare Beneficiaries | 418 |
| Total Submitted Charge Amount | 180934 |
| Total Medicare Allowed Amount | 141937.41 |
| Total Medicare Payment Amount | 106094.91 |
| Total Medicare Standardized Payment Amount | 99569.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 71 |
| Number Of Medicare Beneficiaries With Drug Services | 58 |
| Total Drug Submitted ChargeAmount | 1285 |
| Total Drug Medicare AllowedAmount | 947 |
| Total Drug Medicare PaymentAmount | 926.96 |
| Total Drug Medicare Standardized Payment Amount | 926.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 1746 |
| Number Of Medicare Beneficiaries With Medical Services | 418 |
| Total Medical Submitted Charge Amount | 179649 |
| Total Medical Medicare Allowed Amount | 140990.41 |
| Total Medical Medicare Payment Amount | 105167.95 |
| Total Medical Medicare Standardized Payment Amount | 98642.7 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 173 |
| Number Of Beneficiaries Age 75 to 84 | 134 |
| Number Of Beneficiaries Age Greater 84 | 59 |
| Number Of Female Beneficiaries | 232 |
| Number Of Male Beneficiaries | 186 |
| Number Of Non Hispanic White Beneficiaries | 365 |
| 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 | 384 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 25 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3865 |