| National Provider Identifier [NPI]: | 1184846529 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | MICHELLE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3613 VISTA WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | OCEANSIDE |
| Zip Code Of The Provider | 920564522 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 8504 |
| Number Of Medicare Beneficiaries | 2333 |
| Total Submitted Charge Amount | 1143771 |
| Total Medicare Allowed Amount | 435540.23 |
| Total Medicare Payment Amount | 328091.48 |
| Total Medicare Standardized Payment Amount | 284456.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 2120 |
| Total Drug Medicare AllowedAmount | 1103.94 |
| Total Drug Medicare PaymentAmount | 859.85 |
| Total Drug Medicare Standardized Payment Amount | 859.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 8428 |
| Number Of Medicare Beneficiaries With Medical Services | 2333 |
| Total Medical Submitted Charge Amount | 1141651 |
| Total Medical Medicare Allowed Amount | 434436.29 |
| Total Medical Medicare Payment Amount | 327231.63 |
| Total Medical Medicare Standardized Payment Amount | 283596.77 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 79 |
| Number Of Beneficiaries Age 65 to 74 | 1060 |
| Number Of Beneficiaries Age 75 to 84 | 763 |
| Number Of Beneficiaries Age Greater 84 | 431 |
| Number Of Female Beneficiaries | 1303 |
| Number Of Male Beneficiaries | 1030 |
| Number Of Non Hispanic White Beneficiaries | 2195 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 31 |
| Number Of Hispanic Beneficiaries | 51 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 43 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2246 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 87 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0168 |