| National Provider Identifier [NPI]: | 1730258708 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | SHAWN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M,D, |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 E PRIMROSE ST STE 550 |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 658075180 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 6507 |
| Number Of Medicare Beneficiaries | 2492 |
| Total Submitted Charge Amount | 525160.45 |
| Total Medicare Allowed Amount | 216741.28 |
| Total Medicare Payment Amount | 155809.27 |
| Total Medicare Standardized Payment Amount | 128906.51 |
| 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 | 21 |
| Number Of Medical Services | 6507 |
| Number Of Medicare Beneficiaries With Medical Services | 2492 |
| Total Medical Submitted Charge Amount | 525160.45 |
| Total Medical Medicare Allowed Amount | 216741.28 |
| Total Medical Medicare Payment Amount | 155809.27 |
| Total Medical Medicare Standardized Payment Amount | 128906.51 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 352 |
| Number Of Beneficiaries Age 65 to 74 | 1065 |
| Number Of Beneficiaries Age 75 to 84 | 768 |
| Number Of Beneficiaries Age Greater 84 | 307 |
| Number Of Female Beneficiaries | 1142 |
| Number Of Male Beneficiaries | 1350 |
| Number Of Non Hispanic White Beneficiaries | 2433 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2151 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 341 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1002 |