| National Provider Identifier [NPI]: | 1811975873 |
| Last Name Of The Provider | JACOBS |
| First Name Of The Provider | WAYNE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3061 S MARYLAND PKWY |
| Street Address 2 Of The Provider | SUITE 102 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891092298 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 157 |
| Number Of Services | 7903 |
| Number Of Medicare Beneficiaries | 4584 |
| Total Submitted Charge Amount | 652878 |
| Total Medicare Allowed Amount | 221520.76 |
| Total Medicare Payment Amount | 168551.06 |
| Total Medicare Standardized Payment Amount | 167274.68 |
| 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 | 157 |
| Number Of Medical Services | 7903 |
| Number Of Medicare Beneficiaries With Medical Services | 4584 |
| Total Medical Submitted Charge Amount | 652878 |
| Total Medical Medicare Allowed Amount | 221520.76 |
| Total Medical Medicare Payment Amount | 168551.06 |
| Total Medical Medicare Standardized Payment Amount | 167274.68 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 932 |
| Number Of Beneficiaries Age 65 to 74 | 1623 |
| Number Of Beneficiaries Age 75 to 84 | 1349 |
| Number Of Beneficiaries Age Greater 84 | 680 |
| Number Of Female Beneficiaries | 2419 |
| Number Of Male Beneficiaries | 2165 |
| Number Of Non Hispanic White Beneficiaries | 3135 |
| Number Of Black or African American Beneficiaries | 604 |
| Number Of AsianPacific Islander Beneficiaries | 221 |
| Number Of Hispanic Beneficiaries | 516 |
| Number Of American Indian Alaska Native Beneficiaries | 23 |
| Number Of Beneficiaries With Race Not Else where Classified | 85 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3263 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1321 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.2542 |