| National Provider Identifier [NPI]: | 1366451999 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | AMANDA |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4410 106TH ST SW |
| Street Address 2 Of The Provider | |
| City Of The Provider | MUKILTEO |
| Zip Code Of The Provider | 982754700 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 336 |
| Number Of Medicare Beneficiaries | 55 |
| Total Submitted Charge Amount | 32047 |
| Total Medicare Allowed Amount | 13961.63 |
| Total Medicare Payment Amount | 10555.25 |
| Total Medicare Standardized Payment Amount | 10528.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 48 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 1127.5 |
| Total Drug Medicare AllowedAmount | 586.5 |
| Total Drug Medicare PaymentAmount | 310.4 |
| Total Drug Medicare Standardized Payment Amount | 310.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 288 |
| Number Of Medicare Beneficiaries With Medical Services | 53 |
| Total Medical Submitted Charge Amount | 30919.5 |
| Total Medical Medicare Allowed Amount | 13375.13 |
| Total Medical Medicare Payment Amount | 10244.85 |
| Total Medical Medicare Standardized Payment Amount | 10218.08 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 29 |
| Number Of Beneficiaries Age 75 to 84 | 12 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 34 |
| Number Of Male Beneficiaries | 21 |
| 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 | 44 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 27 |
| Percent Of With Hypertension | 38 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 20 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.8385 |