| National Provider Identifier [NPI]: | 1467624809 |
| Last Name Of The Provider | JORDAN |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4949 HARLEM RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | AMHERST |
| Zip Code Of The Provider | 142262500 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 260 |
| Number Of Medicare Beneficiaries | 30 |
| Total Submitted Charge Amount | 13624 |
| Total Medicare Allowed Amount | 5469.94 |
| Total Medicare Payment Amount | 3948.63 |
| Total Medicare Standardized Payment Amount | 4671.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 202 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 3567 |
| Total Drug Medicare AllowedAmount | 2425.93 |
| Total Drug Medicare PaymentAmount | 1875.14 |
| Total Drug Medicare Standardized Payment Amount | 1875.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 58 |
| Number Of Medicare Beneficiaries With Medical Services | 30 |
| Total Medical Submitted Charge Amount | 10057 |
| Total Medical Medicare Allowed Amount | 3044.01 |
| Total Medical Medicare Payment Amount | 2073.49 |
| Total Medical Medicare Standardized Payment Amount | 2796.21 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 19 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | 11 |
| Number Of Male Beneficiaries | 19 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 0 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 0 |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.4952 |