| National Provider Identifier [NPI]: | 1073585238 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | MARK |
| 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 | 1000 PAVILIONS CIRCLE |
| Street Address 2 Of The Provider | MARK A JACKSON MD PLC |
| City Of The Provider | TRAVERSE CITY |
| Zip Code Of The Provider | 49684 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Geriatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 4218 |
| Number Of Medicare Beneficiaries | 786 |
| Total Submitted Charge Amount | 561941 |
| Total Medicare Allowed Amount | 367758.8 |
| Total Medicare Payment Amount | 264206.11 |
| Total Medicare Standardized Payment Amount | 273199.71 |
| 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 | 18 |
| Number Of Medical Services | 4218 |
| Number Of Medicare Beneficiaries With Medical Services | 786 |
| Total Medical Submitted Charge Amount | 561941 |
| Total Medical Medicare Allowed Amount | 367758.8 |
| Total Medical Medicare Payment Amount | 264206.11 |
| Total Medical Medicare Standardized Payment Amount | 273199.71 |
| Average Age Of Beneficiaries | 83 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 111 |
| Number Of Beneficiaries Age 75 to 84 | 220 |
| Number Of Beneficiaries Age Greater 84 | 414 |
| Number Of Female Beneficiaries | 554 |
| Number Of Male Beneficiaries | 232 |
| Number Of Non Hispanic White Beneficiaries | 774 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 427 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 359 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 58 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 51 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.8296 |