| National Provider Identifier [NPI]: | 1437118932 |
| Last Name Of The Provider | JACOBSON |
| First Name Of The Provider | MARC |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1550 N 115TH |
| Street Address 2 Of The Provider | NORTHWEST HOSPITAL |
| City Of The Provider | SEATTLE |
| Zip Code Of The Provider | 98133 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 156 |
| Number Of Services | 12219 |
| Number Of Medicare Beneficiaries | 1946 |
| Total Submitted Charge Amount | 971694.63 |
| Total Medicare Allowed Amount | 325401.85 |
| Total Medicare Payment Amount | 248720.06 |
| Total Medicare Standardized Payment Amount | 241900.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 8629 |
| Number Of Medicare Beneficiaries With Drug Services | 110 |
| Total Drug Submitted ChargeAmount | 3187.54 |
| Total Drug Medicare AllowedAmount | 2698.71 |
| Total Drug Medicare PaymentAmount | 2087.24 |
| Total Drug Medicare Standardized Payment Amount | 2087.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 149 |
| Number Of Medical Services | 3590 |
| Number Of Medicare Beneficiaries With Medical Services | 1946 |
| Total Medical Submitted Charge Amount | 968507.09 |
| Total Medical Medicare Allowed Amount | 322703.14 |
| Total Medical Medicare Payment Amount | 246632.82 |
| Total Medical Medicare Standardized Payment Amount | 239813.09 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 234 |
| Number Of Beneficiaries Age 65 to 74 | 607 |
| Number Of Beneficiaries Age 75 to 84 | 611 |
| Number Of Beneficiaries Age Greater 84 | 494 |
| Number Of Female Beneficiaries | 1179 |
| Number Of Male Beneficiaries | 767 |
| Number Of Non Hispanic White Beneficiaries | 1700 |
| Number Of Black or African American Beneficiaries | 57 |
| Number Of AsianPacific Islander Beneficiaries | 98 |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | 12 |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1506 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 440 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5239 |