| National Provider Identifier [NPI]: | 1073538971 |
| Last Name Of The Provider | SIMON |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 925 CHESTNUT ST |
| Street Address 2 Of The Provider | FIFTH FLOOR |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191074216 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 2668 |
| Number Of Medicare Beneficiaries | 596 |
| Total Submitted Charge Amount | 1015630 |
| Total Medicare Allowed Amount | 218973.71 |
| Total Medicare Payment Amount | 163204.44 |
| Total Medicare Standardized Payment Amount | 146138.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 818 |
| Number Of Medicare Beneficiaries With Drug Services | 207 |
| Total Drug Submitted ChargeAmount | 12728 |
| Total Drug Medicare AllowedAmount | 7238.66 |
| Total Drug Medicare PaymentAmount | 5562.4 |
| Total Drug Medicare Standardized Payment Amount | 5562.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 1850 |
| Number Of Medicare Beneficiaries With Medical Services | 595 |
| Total Medical Submitted Charge Amount | 1002902 |
| Total Medical Medicare Allowed Amount | 211735.05 |
| Total Medical Medicare Payment Amount | 157642.04 |
| Total Medical Medicare Standardized Payment Amount | 140575.67 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 61 |
| Number Of Beneficiaries Age 65 to 74 | 289 |
| Number Of Beneficiaries Age 75 to 84 | 172 |
| Number Of Beneficiaries Age Greater 84 | 74 |
| Number Of Female Beneficiaries | 372 |
| Number Of Male Beneficiaries | 224 |
| Number Of Non Hispanic White Beneficiaries | 535 |
| Number Of Black or African American Beneficiaries | 39 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 564 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 72 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0148 |