| National Provider Identifier [NPI]: | 1053393827 |
| Last Name Of The Provider | HENRY |
| First Name Of The Provider | JAYSON |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 E ROBINSON ST |
| Street Address 2 Of The Provider | SUITE 2200 |
| City Of The Provider | NORMAN |
| Zip Code Of The Provider | 730716697 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 844 |
| Number Of Medicare Beneficiaries | 220 |
| Total Submitted Charge Amount | 70220.78 |
| Total Medicare Allowed Amount | 40880.41 |
| Total Medicare Payment Amount | 26823.71 |
| Total Medicare Standardized Payment Amount | 30228.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 177 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 5694 |
| Total Drug Medicare AllowedAmount | 3741.07 |
| Total Drug Medicare PaymentAmount | 3231.63 |
| Total Drug Medicare Standardized Payment Amount | 3231.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 667 |
| Number Of Medicare Beneficiaries With Medical Services | 220 |
| Total Medical Submitted Charge Amount | 64526.78 |
| Total Medical Medicare Allowed Amount | 37139.34 |
| Total Medical Medicare Payment Amount | 23592.08 |
| Total Medical Medicare Standardized Payment Amount | 26996.48 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 126 |
| Number Of Beneficiaries Age 75 to 84 | 54 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 120 |
| Number Of Male Beneficiaries | 100 |
| Number Of Non Hispanic White Beneficiaries | 203 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 209 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.807 |