| National Provider Identifier [NPI]: | 1649479460 |
| Last Name Of The Provider | GRANESE |
| First Name Of The Provider | JACQUELINE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1065 ASHLEY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOWLING GREEN |
| Zip Code Of The Provider | 421033400 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 138 |
| Number Of Services | 5926 |
| Number Of Medicare Beneficiaries | 1309 |
| Total Submitted Charge Amount | 606108 |
| Total Medicare Allowed Amount | 250403.32 |
| Total Medicare Payment Amount | 191106.75 |
| Total Medicare Standardized Payment Amount | 191845.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 46 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 11600 |
| Total Drug Medicare AllowedAmount | 10673 |
| Total Drug Medicare PaymentAmount | 8342.64 |
| Total Drug Medicare Standardized Payment Amount | 8342.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 137 |
| Number Of Medical Services | 5880 |
| Number Of Medicare Beneficiaries With Medical Services | 1309 |
| Total Medical Submitted Charge Amount | 594508 |
| Total Medical Medicare Allowed Amount | 239730.32 |
| Total Medical Medicare Payment Amount | 182764.11 |
| Total Medical Medicare Standardized Payment Amount | 183502.83 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 240 |
| Number Of Beneficiaries Age 65 to 74 | 592 |
| Number Of Beneficiaries Age 75 to 84 | 358 |
| Number Of Beneficiaries Age Greater 84 | 119 |
| Number Of Female Beneficiaries | 691 |
| Number Of Male Beneficiaries | 618 |
| Number Of Non Hispanic White Beneficiaries | 1254 |
| Number Of Black or African American Beneficiaries | 39 |
| 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 | 1010 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 299 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2201 |