| National Provider Identifier [NPI]: | 1235110693 |
| Last Name Of The Provider | PREM |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 MEDICAL PARK DR |
| Street Address 2 Of The Provider | SUITE 203 |
| City Of The Provider | DOVER |
| Zip Code Of The Provider | 446223207 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 115 |
| Number Of Services | 3627 |
| Number Of Medicare Beneficiaries | 2095 |
| Total Submitted Charge Amount | 1397329.5 |
| Total Medicare Allowed Amount | 371849.68 |
| Total Medicare Payment Amount | 283567.88 |
| Total Medicare Standardized Payment Amount | 289761.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 115 |
| Number Of Medical Services | 3627 |
| Number Of Medicare Beneficiaries With Medical Services | 2095 |
| Total Medical Submitted Charge Amount | 1397329.5 |
| Total Medical Medicare Allowed Amount | 371849.68 |
| Total Medical Medicare Payment Amount | 283567.88 |
| Total Medical Medicare Standardized Payment Amount | 289761.59 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 342 |
| Number Of Beneficiaries Age 65 to 74 | 752 |
| Number Of Beneficiaries Age 75 to 84 | 666 |
| Number Of Beneficiaries Age Greater 84 | 335 |
| Number Of Female Beneficiaries | 1076 |
| Number Of Male Beneficiaries | 1019 |
| Number Of Non Hispanic White Beneficiaries | 1924 |
| Number Of Black or African American Beneficiaries | 126 |
| 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 | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1574 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 521 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.0186 |