| National Provider Identifier [NPI]: | 1710114657 |
| Last Name Of The Provider | BRYAN |
| First Name Of The Provider | JACOB |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2651 WINDSOR ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SUN PRAIRIE |
| Zip Code Of The Provider | 535909825 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 113 |
| Number Of Services | 1045 |
| Number Of Medicare Beneficiaries | 164 |
| Total Submitted Charge Amount | 119559 |
| Total Medicare Allowed Amount | 38430.48 |
| Total Medicare Payment Amount | 29341.26 |
| Total Medicare Standardized Payment Amount | 30457.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 45 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 2498 |
| Total Drug Medicare AllowedAmount | 1446.1 |
| Total Drug Medicare PaymentAmount | 1412.26 |
| Total Drug Medicare Standardized Payment Amount | 1412.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 105 |
| Number Of Medical Services | 1000 |
| Number Of Medicare Beneficiaries With Medical Services | 164 |
| Total Medical Submitted Charge Amount | 117061 |
| Total Medical Medicare Allowed Amount | 36984.38 |
| Total Medical Medicare Payment Amount | 27929 |
| Total Medical Medicare Standardized Payment Amount | 29045.25 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 76 |
| Number Of Beneficiaries Age 75 to 84 | 26 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 85 |
| Number Of Male Beneficiaries | 79 |
| Number Of Non Hispanic White Beneficiaries | 151 |
| 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 | 118 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3724 |