| National Provider Identifier [NPI]: | 1891984290 |
| Last Name Of The Provider | ETHINGTON |
| First Name Of The Provider | JON-DAVID |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3000 SHAKERAG HL |
| Street Address 2 Of The Provider | |
| City Of The Provider | PEACHTREE CITY |
| Zip Code Of The Provider | 302693365 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 814 |
| Number Of Medicare Beneficiaries | 696 |
| Total Submitted Charge Amount | 47423 |
| Total Medicare Allowed Amount | 18095.85 |
| Total Medicare Payment Amount | 13298.04 |
| Total Medicare Standardized Payment Amount | 16171 |
| 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 | 15 |
| Number Of Medical Services | 814 |
| Number Of Medicare Beneficiaries With Medical Services | 696 |
| Total Medical Submitted Charge Amount | 47423 |
| Total Medical Medicare Allowed Amount | 18095.85 |
| Total Medical Medicare Payment Amount | 13298.04 |
| Total Medical Medicare Standardized Payment Amount | 16171 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 85 |
| Number Of Beneficiaries Age 65 to 74 | 253 |
| Number Of Beneficiaries Age 75 to 84 | 262 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 308 |
| Number Of Male Beneficiaries | 388 |
| Number Of Non Hispanic White Beneficiaries | 622 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 613 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 83 |
| Percent Of With Atrial Fibrillation | 32 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6981 |