| National Provider Identifier [NPI]: | 1285603621 |
| Last Name Of The Provider | DOUGLAS |
| First Name Of The Provider | JERRY |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 15322 LAKESHORE DR |
| Street Address 2 Of The Provider | SUITE 202 |
| City Of The Provider | CLEARLAKE |
| Zip Code Of The Provider | 954229814 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 3936 |
| Number Of Medicare Beneficiaries | 772 |
| Total Submitted Charge Amount | 589732.38 |
| Total Medicare Allowed Amount | 274703.92 |
| Total Medicare Payment Amount | 185475.52 |
| Total Medicare Standardized Payment Amount | 178765.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 267 |
| Number Of Medicare Beneficiaries With Drug Services | 147 |
| Total Drug Submitted ChargeAmount | 11933 |
| Total Drug Medicare AllowedAmount | 7824.09 |
| Total Drug Medicare PaymentAmount | 7594.13 |
| Total Drug Medicare Standardized Payment Amount | 7594.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 3669 |
| Number Of Medicare Beneficiaries With Medical Services | 770 |
| Total Medical Submitted Charge Amount | 577799.38 |
| Total Medical Medicare Allowed Amount | 266879.83 |
| Total Medical Medicare Payment Amount | 177881.39 |
| Total Medical Medicare Standardized Payment Amount | 171171.22 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 175 |
| Number Of Beneficiaries Age 65 to 74 | 297 |
| Number Of Beneficiaries Age 75 to 84 | 217 |
| Number Of Beneficiaries Age Greater 84 | 83 |
| Number Of Female Beneficiaries | 451 |
| Number Of Male Beneficiaries | 321 |
| Number Of Non Hispanic White Beneficiaries | 717 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 526 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 246 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2714 |