| National Provider Identifier [NPI]: | 1518960558 |
| Last Name Of The Provider | JAMESON |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1302 PENNSYLVANIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAGERSTOWN |
| Zip Code Of The Provider | 217423108 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 7217 |
| Number Of Medicare Beneficiaries | 55 |
| Total Submitted Charge Amount | 28301.36 |
| Total Medicare Allowed Amount | 19328.83 |
| Total Medicare Payment Amount | 15000.5 |
| Total Medicare Standardized Payment Amount | 15476.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 7030 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 11148.25 |
| Total Drug Medicare AllowedAmount | 11027.65 |
| Total Drug Medicare PaymentAmount | 8752.71 |
| Total Drug Medicare Standardized Payment Amount | 8752.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 187 |
| Number Of Medicare Beneficiaries With Medical Services | 49 |
| Total Medical Submitted Charge Amount | 17153.11 |
| Total Medical Medicare Allowed Amount | 8301.18 |
| Total Medical Medicare Payment Amount | 6247.79 |
| Total Medical Medicare Standardized Payment Amount | 6723.82 |
| Average Age Of Beneficiaries | 53 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 28 |
| Number Of Male Beneficiaries | 27 |
| Number Of Non Hispanic White Beneficiaries | 42 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 22 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| 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 | 42 |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 27 |
| Percent Of With Hypertension | 35 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.036 |