| National Provider Identifier [NPI]: | 1033431903 |
| Last Name Of The Provider | CLEAVER |
| First Name Of The Provider | JONATHAN |
| 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 | 1316 COUNTRY CLUB DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | KIRKSVILLE |
| Zip Code Of The Provider | 635015362 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 99 |
| Number Of Services | 13091 |
| Number Of Medicare Beneficiaries | 2037 |
| Total Submitted Charge Amount | 873629.22 |
| Total Medicare Allowed Amount | 789904.3 |
| Total Medicare Payment Amount | 586500.56 |
| Total Medicare Standardized Payment Amount | 620411.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 181 |
| Number Of Medicare Beneficiaries With Drug Services | 109 |
| Total Drug Submitted ChargeAmount | 26633.87 |
| Total Drug Medicare AllowedAmount | 26301.36 |
| Total Drug Medicare PaymentAmount | 20474.97 |
| Total Drug Medicare Standardized Payment Amount | 20474.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 97 |
| Number Of Medical Services | 12910 |
| Number Of Medicare Beneficiaries With Medical Services | 2037 |
| Total Medical Submitted Charge Amount | 846995.35 |
| Total Medical Medicare Allowed Amount | 763602.94 |
| Total Medical Medicare Payment Amount | 566025.59 |
| Total Medical Medicare Standardized Payment Amount | 599936.72 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 159 |
| Number Of Beneficiaries Age 65 to 74 | 791 |
| Number Of Beneficiaries Age 75 to 84 | 735 |
| Number Of Beneficiaries Age Greater 84 | 352 |
| Number Of Female Beneficiaries | 1039 |
| Number Of Male Beneficiaries | 998 |
| Number Of Non Hispanic White Beneficiaries | 2013 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1779 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 258 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.991 |