| National Provider Identifier [NPI]: | 1942267448 |
| Last Name Of The Provider | JACOB |
| First Name Of The Provider | MOHAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 18955 MEMORIAL NORTH |
| Street Address 2 Of The Provider | SUITE 440 |
| City Of The Provider | HUMBLE |
| Zip Code Of The Provider | 77338 |
| 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 | 44 |
| Number Of Services | 5984 |
| Number Of Medicare Beneficiaries | 681 |
| Total Submitted Charge Amount | 2151918.39 |
| Total Medicare Allowed Amount | 779951.62 |
| Total Medicare Payment Amount | 593616.81 |
| Total Medicare Standardized Payment Amount | 578908.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 56 |
| Total Drug Submitted ChargeAmount | 11325 |
| Total Drug Medicare AllowedAmount | 1521.45 |
| Total Drug Medicare PaymentAmount | 1192.89 |
| Total Drug Medicare Standardized Payment Amount | 1192.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 5908 |
| Number Of Medicare Beneficiaries With Medical Services | 681 |
| Total Medical Submitted Charge Amount | 2140593.39 |
| Total Medical Medicare Allowed Amount | 778430.17 |
| Total Medical Medicare Payment Amount | 592423.92 |
| Total Medical Medicare Standardized Payment Amount | 577715.78 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 66 |
| Number Of Beneficiaries Age 65 to 74 | 275 |
| Number Of Beneficiaries Age 75 to 84 | 230 |
| Number Of Beneficiaries Age Greater 84 | 110 |
| Number Of Female Beneficiaries | 395 |
| Number Of Male Beneficiaries | 286 |
| Number Of Non Hispanic White Beneficiaries | 508 |
| Number Of Black or African American Beneficiaries | 111 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 48 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 567 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 114 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 48 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 65 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.0936 |