| National Provider Identifier [NPI]: | 1821196627 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2003 MEDICAL PARKWAY |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | ANNAPOLIS |
| Zip Code Of The Provider | 21401 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 4404 |
| Number Of Medicare Beneficiaries | 600 |
| Total Submitted Charge Amount | 412493 |
| Total Medicare Allowed Amount | 282377.85 |
| Total Medicare Payment Amount | 212300.5 |
| Total Medicare Standardized Payment Amount | 201393.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 298 |
| Number Of Medicare Beneficiaries With Drug Services | 219 |
| Total Drug Submitted ChargeAmount | 13191 |
| Total Drug Medicare AllowedAmount | 9421.07 |
| Total Drug Medicare PaymentAmount | 8970.38 |
| Total Drug Medicare Standardized Payment Amount | 8970.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 4106 |
| Number Of Medicare Beneficiaries With Medical Services | 600 |
| Total Medical Submitted Charge Amount | 399302 |
| Total Medical Medicare Allowed Amount | 272956.78 |
| Total Medical Medicare Payment Amount | 203330.12 |
| Total Medical Medicare Standardized Payment Amount | 192423.35 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 277 |
| Number Of Beneficiaries Age 75 to 84 | 206 |
| Number Of Beneficiaries Age Greater 84 | 104 |
| Number Of Female Beneficiaries | 295 |
| Number Of Male Beneficiaries | 305 |
| Number Of Non Hispanic White Beneficiaries | 502 |
| Number Of Black or African American Beneficiaries | 76 |
| 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 | 586 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8994 |