| National Provider Identifier [NPI]: | 1184771073 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | TAMARA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 469 W HURON ST |
| Street Address 2 Of The Provider | APT 810 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606543467 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 189 |
| Number Of Services | 5214 |
| Number Of Medicare Beneficiaries | 3220 |
| Total Submitted Charge Amount | 849576 |
| Total Medicare Allowed Amount | 187412.48 |
| Total Medicare Payment Amount | 137872.67 |
| Total Medicare Standardized Payment Amount | 132178.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 189 |
| Number Of Medical Services | 5214 |
| Number Of Medicare Beneficiaries With Medical Services | 3220 |
| Total Medical Submitted Charge Amount | 849576 |
| Total Medical Medicare Allowed Amount | 187412.48 |
| Total Medical Medicare Payment Amount | 137872.67 |
| Total Medical Medicare Standardized Payment Amount | 132178.35 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 370 |
| Number Of Beneficiaries Age 65 to 74 | 1093 |
| Number Of Beneficiaries Age 75 to 84 | 1035 |
| Number Of Beneficiaries Age Greater 84 | 722 |
| Number Of Female Beneficiaries | 2040 |
| Number Of Male Beneficiaries | 1180 |
| Number Of Non Hispanic White Beneficiaries | 2731 |
| Number Of Black or African American Beneficiaries | 175 |
| Number Of AsianPacific Islander Beneficiaries | 116 |
| Number Of Hispanic Beneficiaries | 150 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2584 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 636 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.727 |