| National Provider Identifier [NPI]: | 1346422532 |
| Last Name Of The Provider | JETTER |
| First Name Of The Provider | GINA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4801 TROUP HWY |
| Street Address 2 Of The Provider | STE 201 |
| City Of The Provider | TYLER |
| Zip Code Of The Provider | 757032356 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 2854 |
| Number Of Medicare Beneficiaries | 640 |
| Total Submitted Charge Amount | 258681 |
| Total Medicare Allowed Amount | 248634.85 |
| Total Medicare Payment Amount | 186504.73 |
| Total Medicare Standardized Payment Amount | 197580.78 |
| Drug Suppress Indicator | * |
| Number Of HCPCS Associated With Drug Services | |
| Number Of Drug Services | |
| Number Of Medicare Beneficiaries With Drug Services | |
| Total Drug Submitted ChargeAmount | |
| Total Drug Medicare AllowedAmount | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
| Number Of Medical Services | |
| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Total Medical Medicare Standardized Payment Amount | |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 173 |
| Number Of Beneficiaries Age 65 to 74 | 218 |
| Number Of Beneficiaries Age 75 to 84 | 174 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 357 |
| Number Of Male Beneficiaries | 283 |
| Number Of Non Hispanic White Beneficiaries | 544 |
| Number Of Black or African American Beneficiaries | 75 |
| 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 | 461 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 179 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 33 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 33 |
| Average HCC Risk Score Of Beneficiaries | 1.8348 |