| National Provider Identifier [NPI]: | 1245317429 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1033 E MOUNT PLEASANT RD |
| Street Address 2 Of The Provider | SUITE D |
| City Of The Provider | EVANSVILLE |
| Zip Code Of The Provider | 477257149 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 2929 |
| Number Of Medicare Beneficiaries | 637 |
| Total Submitted Charge Amount | 373695.9 |
| Total Medicare Allowed Amount | 183865.04 |
| Total Medicare Payment Amount | 135452 |
| Total Medicare Standardized Payment Amount | 116923.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 425 |
| Number Of Medicare Beneficiaries With Drug Services | 132 |
| Total Drug Submitted ChargeAmount | 12555.5 |
| Total Drug Medicare AllowedAmount | 4873.48 |
| Total Drug Medicare PaymentAmount | 4536.32 |
| Total Drug Medicare Standardized Payment Amount | 4536.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 2504 |
| Number Of Medicare Beneficiaries With Medical Services | 637 |
| Total Medical Submitted Charge Amount | 361140.4 |
| Total Medical Medicare Allowed Amount | 178991.56 |
| Total Medical Medicare Payment Amount | 130915.68 |
| Total Medical Medicare Standardized Payment Amount | 112387.42 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 84 |
| Number Of Beneficiaries Age 65 to 74 | 258 |
| Number Of Beneficiaries Age 75 to 84 | 205 |
| Number Of Beneficiaries Age Greater 84 | 90 |
| Number Of Female Beneficiaries | 335 |
| Number Of Male Beneficiaries | 302 |
| Number Of Non Hispanic White Beneficiaries | 603 |
| Number Of Black or African American Beneficiaries | 20 |
| 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 | 515 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 122 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5051 |