| National Provider Identifier [NPI]: | 1871559856 |
| Last Name Of The Provider | JAIN |
| First Name Of The Provider | MANOJ |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 SAN PABLO RD S |
| Street Address 2 Of The Provider | PROVIDER ENROLLMENT |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322241865 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 90 |
| Number Of Services | 30851 |
| Number Of Medicare Beneficiaries | 1749 |
| Total Submitted Charge Amount | 1747150.69 |
| Total Medicare Allowed Amount | 1470695.58 |
| Total Medicare Payment Amount | 1131113.37 |
| Total Medicare Standardized Payment Amount | 1170225.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 26678 |
| Number Of Medicare Beneficiaries With Drug Services | 138 |
| Total Drug Submitted ChargeAmount | 8505.13 |
| Total Drug Medicare AllowedAmount | 5020.76 |
| Total Drug Medicare PaymentAmount | 3812.34 |
| Total Drug Medicare Standardized Payment Amount | 3812.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 87 |
| Number Of Medical Services | 4173 |
| Number Of Medicare Beneficiaries With Medical Services | 1749 |
| Total Medical Submitted Charge Amount | 1738645.56 |
| Total Medical Medicare Allowed Amount | 1465674.82 |
| Total Medical Medicare Payment Amount | 1127301.03 |
| Total Medical Medicare Standardized Payment Amount | 1166412.85 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 225 |
| Number Of Beneficiaries Age 65 to 74 | 737 |
| Number Of Beneficiaries Age 75 to 84 | 573 |
| Number Of Beneficiaries Age Greater 84 | 214 |
| Number Of Female Beneficiaries | 813 |
| Number Of Male Beneficiaries | 936 |
| Number Of Non Hispanic White Beneficiaries | 1525 |
| Number Of Black or African American Beneficiaries | 139 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1632 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 117 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 29 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.836 |