| National Provider Identifier [NPI]: | 1356314124 |
| Last Name Of The Provider | JACKS |
| First Name Of The Provider | RANDAL |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 774 LANDA ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEW BRAUNFELS |
| Zip Code Of The Provider | 781306114 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 108 |
| Number Of Services | 4542 |
| Number Of Medicare Beneficiaries | 521 |
| Total Submitted Charge Amount | 189029.81 |
| Total Medicare Allowed Amount | 185011.19 |
| Total Medicare Payment Amount | 137866.85 |
| Total Medicare Standardized Payment Amount | 143908.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 1087 |
| Number Of Medicare Beneficiaries With Drug Services | 226 |
| Total Drug Submitted ChargeAmount | 19358.23 |
| Total Drug Medicare AllowedAmount | 19282.35 |
| Total Drug Medicare PaymentAmount | 16606.75 |
| Total Drug Medicare Standardized Payment Amount | 16606.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 92 |
| Number Of Medical Services | 3455 |
| Number Of Medicare Beneficiaries With Medical Services | 521 |
| Total Medical Submitted Charge Amount | 169671.58 |
| Total Medical Medicare Allowed Amount | 165728.84 |
| Total Medical Medicare Payment Amount | 121260.1 |
| Total Medical Medicare Standardized Payment Amount | 127301.28 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 273 |
| Number Of Beneficiaries Age 75 to 84 | 157 |
| Number Of Beneficiaries Age Greater 84 | 74 |
| Number Of Female Beneficiaries | 288 |
| Number Of Male Beneficiaries | 233 |
| Number Of Non Hispanic White Beneficiaries | 481 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 497 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.941 |