| National Provider Identifier [NPI]: | 1801857941 |
| Last Name Of The Provider | JEFFERSON |
| First Name Of The Provider | ANDREVIUS |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 655 W 8TH ST |
| Street Address 2 Of The Provider | UFJP CRITICAL CARE |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322096511 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 187 |
| Number Of Medicare Beneficiaries | 144 |
| Total Submitted Charge Amount | 169028 |
| Total Medicare Allowed Amount | 15432.84 |
| Total Medicare Payment Amount | 11640.08 |
| Total Medicare Standardized Payment Amount | 14210.84 |
| 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 | 13 |
| Number Of Medical Services | 187 |
| Number Of Medicare Beneficiaries With Medical Services | 144 |
| Total Medical Submitted Charge Amount | 169028 |
| Total Medical Medicare Allowed Amount | 15432.84 |
| Total Medical Medicare Payment Amount | 11640.08 |
| Total Medical Medicare Standardized Payment Amount | 14210.84 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 45 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 91 |
| Number Of Male Beneficiaries | 53 |
| Number Of Non Hispanic White Beneficiaries | 86 |
| 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 | 76 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.572 |