| National Provider Identifier [NPI]: | 1639405061 |
| Last Name Of The Provider | GRAY |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4504 N. LAURENT ST. |
| Street Address 2 Of The Provider | |
| City Of The Provider | VICTORIA |
| Zip Code Of The Provider | 77901 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 182 |
| Number Of Medicare Beneficiaries | 34 |
| Total Submitted Charge Amount | 8931 |
| Total Medicare Allowed Amount | 4399.54 |
| Total Medicare Payment Amount | 2997.32 |
| Total Medicare Standardized Payment Amount | 3423.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 104 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 2130 |
| Total Drug Medicare AllowedAmount | 197.13 |
| Total Drug Medicare PaymentAmount | 130.63 |
| Total Drug Medicare Standardized Payment Amount | 130.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 78 |
| Number Of Medicare Beneficiaries With Medical Services | 34 |
| Total Medical Submitted Charge Amount | 6801 |
| Total Medical Medicare Allowed Amount | 4202.41 |
| Total Medical Medicare Payment Amount | 2866.69 |
| Total Medical Medicare Standardized Payment Amount | 3293.03 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 19 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 20 |
| Number Of Male Beneficiaries | 14 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7318 |