| National Provider Identifier [NPI]: | 1336162890 |
| Last Name Of The Provider | JACQUES |
| First Name Of The Provider | CHARLIE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1380 E MEDICAL CENTER DR |
| Street Address 2 Of The Provider | SUITE #1400 |
| City Of The Provider | ST GEORGE |
| Zip Code Of The Provider | 847902123 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 487 |
| Number Of Medicare Beneficiaries | 153 |
| Total Submitted Charge Amount | 41241 |
| Total Medicare Allowed Amount | 25235.84 |
| Total Medicare Payment Amount | 15549.78 |
| Total Medicare Standardized Payment Amount | 19923.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 56 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 947 |
| Total Drug Medicare AllowedAmount | 471 |
| Total Drug Medicare PaymentAmount | 365.93 |
| Total Drug Medicare Standardized Payment Amount | 365.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 431 |
| Number Of Medicare Beneficiaries With Medical Services | 153 |
| Total Medical Submitted Charge Amount | 40294 |
| Total Medical Medicare Allowed Amount | 24764.84 |
| Total Medical Medicare Payment Amount | 15183.85 |
| Total Medical Medicare Standardized Payment Amount | 19557.48 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 71 |
| Number Of Beneficiaries Age 75 to 84 | 40 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 84 |
| Number Of Male Beneficiaries | 69 |
| 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 | 127 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 26 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.0027 |