| National Provider Identifier [NPI]: | 1588904866 |
| Last Name Of The Provider | CHAN |
| First Name Of The Provider | JESSIE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 W FAIRBANKS AVE |
| Street Address 2 Of The Provider | STE E |
| City Of The Provider | WINTER PARK |
| Zip Code Of The Provider | 327895084 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 1611 |
| Number Of Medicare Beneficiaries | 350 |
| Total Submitted Charge Amount | 171985 |
| Total Medicare Allowed Amount | 82171.03 |
| Total Medicare Payment Amount | 59770.01 |
| Total Medicare Standardized Payment Amount | 69503.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 3051 |
| Total Drug Medicare AllowedAmount | 2354.55 |
| Total Drug Medicare PaymentAmount | 1805.71 |
| Total Drug Medicare Standardized Payment Amount | 1805.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 1535 |
| Number Of Medicare Beneficiaries With Medical Services | 350 |
| Total Medical Submitted Charge Amount | 168934 |
| Total Medical Medicare Allowed Amount | 79816.48 |
| Total Medical Medicare Payment Amount | 57964.3 |
| Total Medical Medicare Standardized Payment Amount | 67697.76 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 188 |
| Number Of Beneficiaries Age 75 to 84 | 93 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 207 |
| Number Of Male Beneficiaries | 143 |
| Number Of Non Hispanic White Beneficiaries | 318 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 316 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0635 |