| National Provider Identifier [NPI]: | 1235110719 |
| Last Name Of The Provider | LEIDLEIN |
| First Name Of The Provider | JANE |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 117 CIRCLE WAY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKE JACKSON |
| Zip Code Of The Provider | 775665233 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 5443 |
| Number Of Medicare Beneficiaries | 993 |
| Total Submitted Charge Amount | 2218066.5 |
| Total Medicare Allowed Amount | 820745.13 |
| Total Medicare Payment Amount | 605631.47 |
| Total Medicare Standardized Payment Amount | 600037.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 966 |
| Number Of Medicare Beneficiaries With Drug Services | 111 |
| Total Drug Submitted ChargeAmount | 382814 |
| Total Drug Medicare AllowedAmount | 323202.09 |
| Total Drug Medicare PaymentAmount | 246607.07 |
| Total Drug Medicare Standardized Payment Amount | 246607.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 4477 |
| Number Of Medicare Beneficiaries With Medical Services | 993 |
| Total Medical Submitted Charge Amount | 1835252.5 |
| Total Medical Medicare Allowed Amount | 497543.04 |
| Total Medical Medicare Payment Amount | 359024.4 |
| Total Medical Medicare Standardized Payment Amount | 353430.57 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 406 |
| Number Of Beneficiaries Age 75 to 84 | 389 |
| Number Of Beneficiaries Age Greater 84 | 149 |
| Number Of Female Beneficiaries | 631 |
| Number Of Male Beneficiaries | 362 |
| Number Of Non Hispanic White Beneficiaries | 851 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 94 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 902 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 91 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1148 |