| National Provider Identifier [NPI]: | 1417033051 |
| Last Name Of The Provider | JACOB |
| First Name Of The Provider | JASON |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1304 FAWCETT AVE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | TACOMA |
| Zip Code Of The Provider | 984021911 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 119 |
| Number Of Services | 11431 |
| Number Of Medicare Beneficiaries | 1908 |
| Total Submitted Charge Amount | 750106.5 |
| Total Medicare Allowed Amount | 174835.16 |
| Total Medicare Payment Amount | 130982.35 |
| Total Medicare Standardized Payment Amount | 132561.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 8679 |
| Number Of Medicare Beneficiaries With Drug Services | 112 |
| Total Drug Submitted ChargeAmount | 12145.5 |
| Total Drug Medicare AllowedAmount | 2760.5 |
| Total Drug Medicare PaymentAmount | 2133.73 |
| Total Drug Medicare Standardized Payment Amount | 2133.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 116 |
| Number Of Medical Services | 2752 |
| Number Of Medicare Beneficiaries With Medical Services | 1908 |
| Total Medical Submitted Charge Amount | 737961 |
| Total Medical Medicare Allowed Amount | 172074.66 |
| Total Medical Medicare Payment Amount | 128848.62 |
| Total Medical Medicare Standardized Payment Amount | 130427.29 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 343 |
| Number Of Beneficiaries Age 65 to 74 | 679 |
| Number Of Beneficiaries Age 75 to 84 | 602 |
| Number Of Beneficiaries Age Greater 84 | 284 |
| Number Of Female Beneficiaries | 1116 |
| Number Of Male Beneficiaries | 792 |
| Number Of Non Hispanic White Beneficiaries | 1535 |
| Number Of Black or African American Beneficiaries | 121 |
| Number Of AsianPacific Islander Beneficiaries | 131 |
| Number Of Hispanic Beneficiaries | 57 |
| Number Of American Indian Alaska Native Beneficiaries | 18 |
| Number Of Beneficiaries With Race Not Else where Classified | 46 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1405 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 503 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7076 |