| National Provider Identifier [NPI]: | 1477500288 |
| Last Name Of The Provider | JACOBSON |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 SAINT MARY PL |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHREVEPORT |
| Zip Code Of The Provider | 711014343 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 1774 |
| Number Of Medicare Beneficiaries | 999 |
| Total Submitted Charge Amount | 208589 |
| Total Medicare Allowed Amount | 176319.44 |
| Total Medicare Payment Amount | 132887.29 |
| Total Medicare Standardized Payment Amount | 136873.95 |
| 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 | 36 |
| Number Of Medical Services | 1774 |
| Number Of Medicare Beneficiaries With Medical Services | 999 |
| Total Medical Submitted Charge Amount | 208589 |
| Total Medical Medicare Allowed Amount | 176319.44 |
| Total Medical Medicare Payment Amount | 132887.29 |
| Total Medical Medicare Standardized Payment Amount | 136873.95 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 215 |
| Number Of Beneficiaries Age 65 to 74 | 282 |
| Number Of Beneficiaries Age 75 to 84 | 292 |
| Number Of Beneficiaries Age Greater 84 | 210 |
| Number Of Female Beneficiaries | 625 |
| Number Of Male Beneficiaries | 374 |
| Number Of Non Hispanic White Beneficiaries | 719 |
| Number Of Black or African American Beneficiaries | 253 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 671 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 328 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 62 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.1502 |