| National Provider Identifier [NPI]: | 1255512984 |
| Last Name Of The Provider | JACKSON |
| First Name Of The Provider | STEPHANIE |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 711 TRESTLE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOCUST GROVE |
| Zip Code Of The Provider | 302483465 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 1099 |
| Number Of Medicare Beneficiaries | 505 |
| Total Submitted Charge Amount | 218243 |
| Total Medicare Allowed Amount | 70914.71 |
| Total Medicare Payment Amount | 54423.35 |
| Total Medicare Standardized Payment Amount | 64295.32 |
| 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 | 23 |
| Number Of Medical Services | 1099 |
| Number Of Medicare Beneficiaries With Medical Services | 505 |
| Total Medical Submitted Charge Amount | 218243 |
| Total Medical Medicare Allowed Amount | 70914.71 |
| Total Medical Medicare Payment Amount | 54423.35 |
| Total Medical Medicare Standardized Payment Amount | 64295.32 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 85 |
| Number Of Beneficiaries Age 65 to 74 | 132 |
| Number Of Beneficiaries Age 75 to 84 | 157 |
| Number Of Beneficiaries Age Greater 84 | 131 |
| Number Of Female Beneficiaries | 310 |
| Number Of Male Beneficiaries | 195 |
| Number Of Non Hispanic White Beneficiaries | 358 |
| Number Of Black or African American Beneficiaries | 136 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 391 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 114 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 37 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.1481 |