| National Provider Identifier [NPI]: | 1932176047 |
| Last Name Of The Provider | JACOBSON |
| First Name Of The Provider | LAURA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 837 CYPRESS CREEK PKWY |
| Street Address 2 Of The Provider | SUITE 105 |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770903423 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 127 |
| Number Of Services | 3882 |
| Number Of Medicare Beneficiaries | 1307 |
| Total Submitted Charge Amount | 1709292.3 |
| Total Medicare Allowed Amount | 136063.02 |
| Total Medicare Payment Amount | 100936.84 |
| Total Medicare Standardized Payment Amount | 102875.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1870 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 17037.5 |
| Total Drug Medicare AllowedAmount | 1430.52 |
| Total Drug Medicare PaymentAmount | 1121.49 |
| Total Drug Medicare Standardized Payment Amount | 1121.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 124 |
| Number Of Medical Services | 2012 |
| Number Of Medicare Beneficiaries With Medical Services | 1307 |
| Total Medical Submitted Charge Amount | 1692254.8 |
| Total Medical Medicare Allowed Amount | 134632.5 |
| Total Medical Medicare Payment Amount | 99815.35 |
| Total Medical Medicare Standardized Payment Amount | 101754.2 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 144 |
| Number Of Beneficiaries Age 65 to 74 | 687 |
| Number Of Beneficiaries Age 75 to 84 | 332 |
| Number Of Beneficiaries Age Greater 84 | 144 |
| Number Of Female Beneficiaries | 800 |
| Number Of Male Beneficiaries | 507 |
| Number Of Non Hispanic White Beneficiaries | 1011 |
| Number Of Black or African American Beneficiaries | 130 |
| Number Of AsianPacific Islander Beneficiaries | 25 |
| Number Of Hispanic Beneficiaries | 126 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1140 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 167 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1881 |