| National Provider Identifier [NPI]: | 1265414171 |
| Last Name Of The Provider | SOLIMAN |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6100 ST JOHNS AVE |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | PALATKA |
| Zip Code Of The Provider | 321773813 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 2629 |
| Number Of Medicare Beneficiaries | 147 |
| Total Submitted Charge Amount | 261979 |
| Total Medicare Allowed Amount | 165395.55 |
| Total Medicare Payment Amount | 121409.61 |
| Total Medicare Standardized Payment Amount | 123829.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 1009 |
| Number Of Medicare Beneficiaries With Drug Services | 125 |
| Total Drug Submitted ChargeAmount | 13547 |
| Total Drug Medicare AllowedAmount | 5623.04 |
| Total Drug Medicare PaymentAmount | 5419.05 |
| Total Drug Medicare Standardized Payment Amount | 5419.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 1620 |
| Number Of Medicare Beneficiaries With Medical Services | 147 |
| Total Medical Submitted Charge Amount | 248432 |
| Total Medical Medicare Allowed Amount | 159772.51 |
| Total Medical Medicare Payment Amount | 115990.56 |
| Total Medical Medicare Standardized Payment Amount | 118410.78 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 63 |
| Number Of Beneficiaries Age 75 to 84 | 49 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 84 |
| Number Of Male Beneficiaries | 63 |
| Number Of Non Hispanic White Beneficiaries | 135 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 130 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 7 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2403 |