| National Provider Identifier [NPI]: | 1780784629 |
| Last Name Of The Provider | FORNCROOK |
| First Name Of The Provider | JONATHON |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2201 COURAGE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | FAIRFIELD |
| Zip Code Of The Provider | 945336733 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 92 |
| Number Of Medicare Beneficiaries | 32 |
| Total Submitted Charge Amount | 19272 |
| Total Medicare Allowed Amount | 6726.61 |
| Total Medicare Payment Amount | 5409.5 |
| Total Medicare Standardized Payment Amount | 5216.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 1079 |
| Total Drug Medicare AllowedAmount | 406.64 |
| Total Drug Medicare PaymentAmount | 397.16 |
| Total Drug Medicare Standardized Payment Amount | 397.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 77 |
| Number Of Medicare Beneficiaries With Medical Services | 32 |
| Total Medical Submitted Charge Amount | 18193 |
| Total Medical Medicare Allowed Amount | 6319.97 |
| Total Medical Medicare Payment Amount | 5012.34 |
| Total Medical Medicare Standardized Payment Amount | 4819.03 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 12 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 17 |
| Number Of Male Beneficiaries | 15 |
| Number Of Non Hispanic White Beneficiaries | 20 |
| Number Of Black or African American Beneficiaries | |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 14 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1033 |