| National Provider Identifier [NPI]: | 1922116029 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | JACOB |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 72 W JIMMIE LEEDS RD |
| Street Address 2 Of The Provider | SUITE 1100 |
| City Of The Provider | GALLOWAY |
| Zip Code Of The Provider | 082059406 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 154 |
| Number Of Services | 44371 |
| Number Of Medicare Beneficiaries | 3026 |
| Total Submitted Charge Amount | 4148436 |
| Total Medicare Allowed Amount | 765876.23 |
| Total Medicare Payment Amount | 585496.4 |
| Total Medicare Standardized Payment Amount | 542163.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 40505 |
| Number Of Medicare Beneficiaries With Drug Services | 758 |
| Total Drug Submitted ChargeAmount | 129919 |
| Total Drug Medicare AllowedAmount | 22636.42 |
| Total Drug Medicare PaymentAmount | 17747.69 |
| Total Drug Medicare Standardized Payment Amount | 17747.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 150 |
| Number Of Medical Services | 3866 |
| Number Of Medicare Beneficiaries With Medical Services | 3024 |
| Total Medical Submitted Charge Amount | 4018517 |
| Total Medical Medicare Allowed Amount | 743239.81 |
| Total Medical Medicare Payment Amount | 567748.71 |
| Total Medical Medicare Standardized Payment Amount | 524415.68 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 399 |
| Number Of Beneficiaries Age 65 to 74 | 1297 |
| Number Of Beneficiaries Age 75 to 84 | 962 |
| Number Of Beneficiaries Age Greater 84 | 368 |
| Number Of Female Beneficiaries | 1778 |
| Number Of Male Beneficiaries | 1248 |
| Number Of Non Hispanic White Beneficiaries | 2601 |
| Number Of Black or African American Beneficiaries | 236 |
| Number Of AsianPacific Islander Beneficiaries | 37 |
| Number Of Hispanic Beneficiaries | 123 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2682 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 344 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.4111 |