| National Provider Identifier [NPI]: | 1811105745 |
| Last Name Of The Provider | JACOBSEN |
| First Name Of The Provider | GREG |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 383 S 300 E |
| Street Address 2 Of The Provider | |
| City Of The Provider | ST GEORGE |
| Zip Code Of The Provider | 847703620 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 89 |
| Number Of Services | 6716 |
| Number Of Medicare Beneficiaries | 1904 |
| Total Submitted Charge Amount | 746251 |
| Total Medicare Allowed Amount | 458777.73 |
| Total Medicare Payment Amount | 319480.57 |
| Total Medicare Standardized Payment Amount | 301608 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 61 |
| Number Of Medicare Beneficiaries With Drug Services | 36 |
| Total Drug Submitted ChargeAmount | 6416 |
| Total Drug Medicare AllowedAmount | 5457.07 |
| Total Drug Medicare PaymentAmount | 4209.68 |
| Total Drug Medicare Standardized Payment Amount | 4209.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 87 |
| Number Of Medical Services | 6655 |
| Number Of Medicare Beneficiaries With Medical Services | 1904 |
| Total Medical Submitted Charge Amount | 739835 |
| Total Medical Medicare Allowed Amount | 453320.66 |
| Total Medical Medicare Payment Amount | 315270.89 |
| Total Medical Medicare Standardized Payment Amount | 297398.32 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 941 |
| Number Of Beneficiaries Age 75 to 84 | 689 |
| Number Of Beneficiaries Age Greater 84 | 227 |
| Number Of Female Beneficiaries | 887 |
| Number Of Male Beneficiaries | 1017 |
| Number Of Non Hispanic White Beneficiaries | 1859 |
| 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 | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1856 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8888 |