| National Provider Identifier [NPI]: | 1508931510 |
| Last Name Of The Provider | GROSSE |
| First Name Of The Provider | JESSICA |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MPAS, PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 111 S 90TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681143907 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 757 |
| Number Of Medicare Beneficiaries | 259 |
| Total Submitted Charge Amount | 94802 |
| Total Medicare Allowed Amount | 27458.3 |
| Total Medicare Payment Amount | 21037.1 |
| Total Medicare Standardized Payment Amount | 25796.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 27 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 10319 |
| Total Drug Medicare AllowedAmount | 3481.67 |
| Total Drug Medicare PaymentAmount | 2716.52 |
| Total Drug Medicare Standardized Payment Amount | 2716.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 730 |
| Number Of Medicare Beneficiaries With Medical Services | 259 |
| Total Medical Submitted Charge Amount | 84483 |
| Total Medical Medicare Allowed Amount | 23976.63 |
| Total Medical Medicare Payment Amount | 18320.58 |
| Total Medical Medicare Standardized Payment Amount | 23079.76 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 123 |
| Number Of Beneficiaries Age 75 to 84 | 92 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 52 |
| Number Of Male Beneficiaries | 207 |
| Number Of Non Hispanic White Beneficiaries | 245 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 239 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 27 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1076 |