| National Provider Identifier [NPI]: | 1992701403 |
| Last Name Of The Provider | HERZOG |
| First Name Of The Provider | JANE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | CRNA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 95429 BARNWELL RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FERNANDINA BEACH |
| Zip Code Of The Provider | 320341698 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | CRNA |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 486 |
| Number Of Medicare Beneficiaries | 466 |
| Total Submitted Charge Amount | 418496 |
| Total Medicare Allowed Amount | 44121.61 |
| Total Medicare Payment Amount | 34113.01 |
| Total Medicare Standardized Payment Amount | 33128.08 |
| 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 | 38 |
| Number Of Medical Services | 486 |
| Number Of Medicare Beneficiaries With Medical Services | 466 |
| Total Medical Submitted Charge Amount | 418496 |
| Total Medical Medicare Allowed Amount | 44121.61 |
| Total Medical Medicare Payment Amount | 34113.01 |
| Total Medical Medicare Standardized Payment Amount | 33128.08 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 240 |
| Number Of Beneficiaries Age 75 to 84 | 136 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 243 |
| Number Of Male Beneficiaries | 223 |
| Number Of Non Hispanic White Beneficiaries | 433 |
| Number Of Black or African American Beneficiaries | 22 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 412 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.244 |