| National Provider Identifier [NPI]: | 1548445281 |
| Last Name Of The Provider | RIDEOUT |
| First Name Of The Provider | JESSE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 462 1ST AVE |
| Street Address 2 Of The Provider | DEPT OF EMERGENCY MEDICINE, RM A340 |
| City Of The Provider | NEW YORK |
| Zip Code Of The Provider | 100169196 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 566 |
| Number Of Medicare Beneficiaries | 513 |
| Total Submitted Charge Amount | 302471 |
| Total Medicare Allowed Amount | 80984.57 |
| Total Medicare Payment Amount | 61891.13 |
| Total Medicare Standardized Payment Amount | 60933.49 |
| 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 | 21 |
| Number Of Medical Services | 566 |
| Number Of Medicare Beneficiaries With Medical Services | 513 |
| Total Medical Submitted Charge Amount | 302471 |
| Total Medical Medicare Allowed Amount | 80984.57 |
| Total Medical Medicare Payment Amount | 61891.13 |
| Total Medical Medicare Standardized Payment Amount | 60933.49 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 208 |
| Number Of Beneficiaries Age 65 to 74 | 128 |
| Number Of Beneficiaries Age 75 to 84 | 105 |
| Number Of Beneficiaries Age Greater 84 | 72 |
| Number Of Female Beneficiaries | 246 |
| Number Of Male Beneficiaries | 267 |
| Number Of Non Hispanic White Beneficiaries | 335 |
| Number Of Black or African American Beneficiaries | 72 |
| Number Of AsianPacific Islander Beneficiaries | 48 |
| Number Of Hispanic Beneficiaries | 46 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 205 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 308 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 19 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.0604 |