| National Provider Identifier [NPI]: | 1306901475 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | GRANT |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 319 E PIONEER AVE |
| Street Address 2 Of The Provider | GRANT W JACKSON MD PS |
| City Of The Provider | MONTESANO |
| Zip Code Of The Provider | 985634601 |
| 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 | 38 |
| Number Of Services | 2296 |
| Number Of Medicare Beneficiaries | 444 |
| Total Submitted Charge Amount | 224384.43 |
| Total Medicare Allowed Amount | 123816.33 |
| Total Medicare Payment Amount | 75894.72 |
| Total Medicare Standardized Payment Amount | 76811.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 78 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 634.05 |
| Total Drug Medicare AllowedAmount | 157.38 |
| Total Drug Medicare PaymentAmount | 119.73 |
| Total Drug Medicare Standardized Payment Amount | 119.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 2218 |
| Number Of Medicare Beneficiaries With Medical Services | 444 |
| Total Medical Submitted Charge Amount | 223750.38 |
| Total Medical Medicare Allowed Amount | 123658.95 |
| Total Medical Medicare Payment Amount | 75774.99 |
| Total Medical Medicare Standardized Payment Amount | 76691.61 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 90 |
| Number Of Beneficiaries Age 65 to 74 | 171 |
| Number Of Beneficiaries Age 75 to 84 | 122 |
| Number Of Beneficiaries Age Greater 84 | 61 |
| Number Of Female Beneficiaries | 228 |
| Number Of Male Beneficiaries | 216 |
| Number Of Non Hispanic White Beneficiaries | 426 |
| 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 | 310 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 134 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0592 |