| National Provider Identifier [NPI]: | 1992745152 |
| Last Name Of The Provider | GOMEZ |
| First Name Of The Provider | JACKELINE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 23511 HOLLYWOOD RD |
| Street Address 2 Of The Provider | SUITE 2 |
| City Of The Provider | LEONARDTOWN |
| Zip Code Of The Provider | 206505833 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 1133 |
| Number Of Medicare Beneficiaries | 496 |
| Total Submitted Charge Amount | 214458 |
| Total Medicare Allowed Amount | 103143.31 |
| Total Medicare Payment Amount | 66410.87 |
| Total Medicare Standardized Payment Amount | 65244.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 90 |
| Number Of Medicare Beneficiaries With Drug Services | 78 |
| Total Drug Submitted ChargeAmount | 1864 |
| Total Drug Medicare AllowedAmount | 1100.23 |
| Total Drug Medicare PaymentAmount | 1070.08 |
| Total Drug Medicare Standardized Payment Amount | 1070.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 1043 |
| Number Of Medicare Beneficiaries With Medical Services | 496 |
| Total Medical Submitted Charge Amount | 212594 |
| Total Medical Medicare Allowed Amount | 102043.08 |
| Total Medical Medicare Payment Amount | 65340.79 |
| Total Medical Medicare Standardized Payment Amount | 64174.36 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 200 |
| Number Of Beneficiaries Age 75 to 84 | 162 |
| Number Of Beneficiaries Age Greater 84 | 74 |
| Number Of Female Beneficiaries | 322 |
| Number Of Male Beneficiaries | 174 |
| Number Of Non Hispanic White Beneficiaries | 474 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 429 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 67 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1534 |