| National Provider Identifier [NPI]: | 1013909316 |
| Last Name Of The Provider | JACKS |
| First Name Of The Provider | DENNIS |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1609 W 40TH AVE |
| Street Address 2 Of The Provider | STE 301 |
| City Of The Provider | PINE BLUFF |
| Zip Code Of The Provider | 716036329 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 8023 |
| Number Of Medicare Beneficiaries | 1541 |
| Total Submitted Charge Amount | 1464982 |
| Total Medicare Allowed Amount | 624828.45 |
| Total Medicare Payment Amount | 461293.24 |
| Total Medicare Standardized Payment Amount | 491355.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 871 |
| Number Of Medicare Beneficiaries With Drug Services | 87 |
| Total Drug Submitted ChargeAmount | 396797 |
| Total Drug Medicare AllowedAmount | 138213.78 |
| Total Drug Medicare PaymentAmount | 105937.09 |
| Total Drug Medicare Standardized Payment Amount | 105937.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 90 |
| Number Of Medical Services | 7152 |
| Number Of Medicare Beneficiaries With Medical Services | 1541 |
| Total Medical Submitted Charge Amount | 1068185 |
| Total Medical Medicare Allowed Amount | 486614.67 |
| Total Medical Medicare Payment Amount | 355356.15 |
| Total Medical Medicare Standardized Payment Amount | 385417.96 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 214 |
| Number Of Beneficiaries Age 65 to 74 | 648 |
| Number Of Beneficiaries Age 75 to 84 | 514 |
| Number Of Beneficiaries Age Greater 84 | 165 |
| Number Of Female Beneficiaries | 369 |
| Number Of Male Beneficiaries | 1172 |
| Number Of Non Hispanic White Beneficiaries | 1155 |
| Number Of Black or African American Beneficiaries | 365 |
| 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 | 1224 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 317 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1163 |