| National Provider Identifier [NPI]: | 1144488685 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | JORDAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5201 HARRY HINES BLVD |
| Street Address 2 Of The Provider | HOUSE STAFF & GME |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 752357708 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 1223 |
| Number Of Medicare Beneficiaries | 673 |
| Total Submitted Charge Amount | 861285 |
| Total Medicare Allowed Amount | 129534.9 |
| Total Medicare Payment Amount | 100045.62 |
| Total Medicare Standardized Payment Amount | 99180.1 |
| 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 | 42 |
| Number Of Medical Services | 1223 |
| Number Of Medicare Beneficiaries With Medical Services | 673 |
| Total Medical Submitted Charge Amount | 861285 |
| Total Medical Medicare Allowed Amount | 129534.9 |
| Total Medical Medicare Payment Amount | 100045.62 |
| Total Medical Medicare Standardized Payment Amount | 99180.1 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 219 |
| Number Of Beneficiaries Age 65 to 74 | 180 |
| Number Of Beneficiaries Age 75 to 84 | 136 |
| Number Of Beneficiaries Age Greater 84 | 138 |
| Number Of Female Beneficiaries | 401 |
| Number Of Male Beneficiaries | 272 |
| Number Of Non Hispanic White Beneficiaries | 254 |
| Number Of Black or African American Beneficiaries | 260 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 97 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 328 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 345 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 34 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.8183 |