| National Provider Identifier [NPI]: | 1124287958 |
| Last Name Of The Provider | IDELSON |
| First Name Of The Provider | JASON |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | D.O |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 PORT WASHINGTON BLVD. |
| Street Address 2 Of The Provider | DEPT. OF EMERGENCY MEDICINE |
| City Of The Provider | ROSLYN |
| Zip Code Of The Provider | 115761347 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Osteopathic Manipulative Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 974 |
| Number Of Medicare Beneficiaries | 632 |
| Total Submitted Charge Amount | 385903.08 |
| Total Medicare Allowed Amount | 117311.64 |
| Total Medicare Payment Amount | 87064.94 |
| Total Medicare Standardized Payment Amount | 76897.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 1761.96 |
| Total Drug Medicare AllowedAmount | 707.69 |
| Total Drug Medicare PaymentAmount | 609.57 |
| Total Drug Medicare Standardized Payment Amount | 609.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 930 |
| Number Of Medicare Beneficiaries With Medical Services | 632 |
| Total Medical Submitted Charge Amount | 384141.12 |
| Total Medical Medicare Allowed Amount | 116603.95 |
| Total Medical Medicare Payment Amount | 86455.37 |
| Total Medical Medicare Standardized Payment Amount | 76287.8 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 79 |
| Number Of Beneficiaries Age 65 to 74 | 225 |
| Number Of Beneficiaries Age 75 to 84 | 188 |
| Number Of Beneficiaries Age Greater 84 | 140 |
| Number Of Female Beneficiaries | 356 |
| Number Of Male Beneficiaries | 276 |
| Number Of Non Hispanic White Beneficiaries | 560 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 540 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 92 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5409 |