| National Provider Identifier [NPI]: | 1306025549 |
| Last Name Of The Provider | JENSEN |
| First Name Of The Provider | EDWIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1175 DEHIRSCH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | WOODBINE |
| Zip Code Of The Provider | 082702401 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 965 |
| Number Of Medicare Beneficiaries | 146 |
| Total Submitted Charge Amount | 84100 |
| Total Medicare Allowed Amount | 74094.03 |
| Total Medicare Payment Amount | 56060.54 |
| Total Medicare Standardized Payment Amount | 52823.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 63 |
| Number Of Medicare Beneficiaries With Drug Services | 63 |
| Total Drug Submitted ChargeAmount | 1260 |
| Total Drug Medicare AllowedAmount | 970.2 |
| Total Drug Medicare PaymentAmount | 950.67 |
| Total Drug Medicare Standardized Payment Amount | 950.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 902 |
| Number Of Medicare Beneficiaries With Medical Services | 146 |
| Total Medical Submitted Charge Amount | 82840 |
| Total Medical Medicare Allowed Amount | 73123.83 |
| Total Medical Medicare Payment Amount | 55109.87 |
| Total Medical Medicare Standardized Payment Amount | 51873.23 |
| Average Age Of Beneficiaries | 57 |
| Number Of Beneficiaries Age Less65 | 110 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 20 |
| Number Of Male Beneficiaries | 126 |
| Number Of Non Hispanic White Beneficiaries | 114 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 27 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 37 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 9 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1437 |