| National Provider Identifier [NPI]: | 1194709402 |
| Last Name Of The Provider | JACOB |
| First Name Of The Provider | SUNI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2543 DIXWELL AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAMDEN |
| Zip Code Of The Provider | 065141860 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 1393 |
| Number Of Medicare Beneficiaries | 466 |
| Total Submitted Charge Amount | 132353.04 |
| Total Medicare Allowed Amount | 72775.81 |
| Total Medicare Payment Amount | 49944.31 |
| Total Medicare Standardized Payment Amount | 55679.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 166 |
| Number Of Medicare Beneficiaries With Drug Services | 98 |
| Total Drug Submitted ChargeAmount | 6460 |
| Total Drug Medicare AllowedAmount | 1794.89 |
| Total Drug Medicare PaymentAmount | 1578.36 |
| Total Drug Medicare Standardized Payment Amount | 1578.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 1227 |
| Number Of Medicare Beneficiaries With Medical Services | 466 |
| Total Medical Submitted Charge Amount | 125893.04 |
| Total Medical Medicare Allowed Amount | 70980.92 |
| Total Medical Medicare Payment Amount | 48365.95 |
| Total Medical Medicare Standardized Payment Amount | 54101.52 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 190 |
| Number Of Beneficiaries Age 65 to 74 | 159 |
| Number Of Beneficiaries Age 75 to 84 | 85 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 297 |
| Number Of Male Beneficiaries | 169 |
| Number Of Non Hispanic White Beneficiaries | 263 |
| Number Of Black or African American Beneficiaries | 133 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 44 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 221 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 245 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1036 |