| National Provider Identifier [NPI]: | 1932185311 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | MELL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 205 W WINDCREST ST |
| Street Address 2 Of The Provider | STE 230 AUSTIN HEART FREDERICKSBURG |
| City Of The Provider | FREDERICKSBURG |
| Zip Code Of The Provider | 786244479 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 5186 |
| Number Of Medicare Beneficiaries | 1361 |
| Total Submitted Charge Amount | 962749.29 |
| Total Medicare Allowed Amount | 401126.27 |
| Total Medicare Payment Amount | 296651.57 |
| Total Medicare Standardized Payment Amount | 314525.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 383 |
| Number Of Medicare Beneficiaries With Drug Services | 98 |
| Total Drug Submitted ChargeAmount | 21186.19 |
| Total Drug Medicare AllowedAmount | 20286.55 |
| Total Drug Medicare PaymentAmount | 15858.11 |
| Total Drug Medicare Standardized Payment Amount | 15858.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 4803 |
| Number Of Medicare Beneficiaries With Medical Services | 1361 |
| Total Medical Submitted Charge Amount | 941563.1 |
| Total Medical Medicare Allowed Amount | 380839.72 |
| Total Medical Medicare Payment Amount | 280793.46 |
| Total Medical Medicare Standardized Payment Amount | 298667.54 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 454 |
| Number Of Beneficiaries Age 75 to 84 | 515 |
| Number Of Beneficiaries Age Greater 84 | 337 |
| Number Of Female Beneficiaries | 689 |
| Number Of Male Beneficiaries | 672 |
| Number Of Non Hispanic White Beneficiaries | 1274 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 63 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1229 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 132 |
| Percent Of With Atrial Fibrillation | 32 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2354 |