| National Provider Identifier [NPI]: | 1679779276 |
| Last Name Of The Provider | PACE |
| First Name Of The Provider | JESSE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 161 E UNIVERSITY DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUBURN |
| Zip Code Of The Provider | 368325889 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 1401 |
| Number Of Medicare Beneficiaries | 200 |
| Total Submitted Charge Amount | 231928 |
| Total Medicare Allowed Amount | 78793.17 |
| Total Medicare Payment Amount | 56029.46 |
| Total Medicare Standardized Payment Amount | 62901.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 784 |
| Number Of Medicare Beneficiaries With Drug Services | 77 |
| Total Drug Submitted ChargeAmount | 14288 |
| Total Drug Medicare AllowedAmount | 1892.63 |
| Total Drug Medicare PaymentAmount | 1002.12 |
| Total Drug Medicare Standardized Payment Amount | 1002.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 617 |
| Number Of Medicare Beneficiaries With Medical Services | 200 |
| Total Medical Submitted Charge Amount | 217640 |
| Total Medical Medicare Allowed Amount | 76900.54 |
| Total Medical Medicare Payment Amount | 55027.34 |
| Total Medical Medicare Standardized Payment Amount | 61899.35 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 90 |
| Number Of Beneficiaries Age 75 to 84 | 49 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 132 |
| Number Of Male Beneficiaries | 68 |
| Number Of Non Hispanic White Beneficiaries | 189 |
| Number Of Black or African American Beneficiaries | 11 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 148 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 71 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1292 |