| National Provider Identifier [NPI]: | 1164552774 |
| Last Name Of The Provider | JENNINGS |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 510 S KINGSHIGHWAY BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631101016 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 121 |
| Number Of Services | 2755 |
| Number Of Medicare Beneficiaries | 1573 |
| Total Submitted Charge Amount | 484804 |
| Total Medicare Allowed Amount | 86576.51 |
| Total Medicare Payment Amount | 66085.72 |
| Total Medicare Standardized Payment Amount | 67780.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 121 |
| Number Of Medical Services | 2755 |
| Number Of Medicare Beneficiaries With Medical Services | 1573 |
| Total Medical Submitted Charge Amount | 484804 |
| Total Medical Medicare Allowed Amount | 86576.51 |
| Total Medical Medicare Payment Amount | 66085.72 |
| Total Medical Medicare Standardized Payment Amount | 67780.55 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 395 |
| Number Of Beneficiaries Age 65 to 74 | 682 |
| Number Of Beneficiaries Age 75 to 84 | 378 |
| Number Of Beneficiaries Age Greater 84 | 118 |
| Number Of Female Beneficiaries | 905 |
| Number Of Male Beneficiaries | 668 |
| Number Of Non Hispanic White Beneficiaries | 1323 |
| Number Of Black or African American Beneficiaries | 204 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1257 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 316 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5596 |