| National Provider Identifier [NPI]: | 1619919750 |
| Last Name Of The Provider | JAIN |
| First Name Of The Provider | SANJAY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD,PHD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 34 UPPER RIVERDALE RD SE |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | RIVERDALE |
| Zip Code Of The Provider | 302742635 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 587 |
| Number Of Medicare Beneficiaries | 181 |
| Total Submitted Charge Amount | 83369 |
| Total Medicare Allowed Amount | 39173.9 |
| Total Medicare Payment Amount | 26866.18 |
| Total Medicare Standardized Payment Amount | 26724.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 105 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 18585 |
| Total Drug Medicare AllowedAmount | 5005.4 |
| Total Drug Medicare PaymentAmount | 3572.61 |
| Total Drug Medicare Standardized Payment Amount | 3572.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 482 |
| Number Of Medicare Beneficiaries With Medical Services | 181 |
| Total Medical Submitted Charge Amount | 64784 |
| Total Medical Medicare Allowed Amount | 34168.5 |
| Total Medical Medicare Payment Amount | 23293.57 |
| Total Medical Medicare Standardized Payment Amount | 23151.76 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 84 |
| Number Of Beneficiaries Age 75 to 84 | 45 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 102 |
| Number Of Male Beneficiaries | 79 |
| Number Of Non Hispanic White Beneficiaries | 42 |
| Number Of Black or African American Beneficiaries | 128 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 106 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 48 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 2.1252 |