| National Provider Identifier [NPI]: | 1801107545 |
| Last Name Of The Provider | GILBERT-GREEN |
| First Name Of The Provider | JACALYN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 201 CASSELL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | KINGSPORT |
| Zip Code Of The Provider | 376603747 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 532 |
| Number Of Medicare Beneficiaries | 184 |
| Total Submitted Charge Amount | 80262 |
| Total Medicare Allowed Amount | 41054.7 |
| Total Medicare Payment Amount | 29297.26 |
| Total Medicare Standardized Payment Amount | 31482.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 571 |
| Total Drug Medicare AllowedAmount | 229.69 |
| Total Drug Medicare PaymentAmount | 218.57 |
| Total Drug Medicare Standardized Payment Amount | 218.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 504 |
| Number Of Medicare Beneficiaries With Medical Services | 184 |
| Total Medical Submitted Charge Amount | 79691 |
| Total Medical Medicare Allowed Amount | 40825.01 |
| Total Medical Medicare Payment Amount | 29078.69 |
| Total Medical Medicare Standardized Payment Amount | 31263.76 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 89 |
| Number Of Beneficiaries Age 65 to 74 | 57 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 118 |
| Number Of Male Beneficiaries | 66 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 52 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 132 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4713 |