| National Provider Identifier [NPI]: | 1992723563 |
| Last Name Of The Provider | JORDAN |
| First Name Of The Provider | ANDREW |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1717 UNIVERSITY DR S |
| Street Address 2 Of The Provider | |
| City Of The Provider | FARGO |
| Zip Code Of The Provider | 581034939 |
| State Code Of The Provider | ND |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 5186 |
| Number Of Medicare Beneficiaries | 881 |
| Total Submitted Charge Amount | 928368.9 |
| Total Medicare Allowed Amount | 433585.78 |
| Total Medicare Payment Amount | 323455 |
| Total Medicare Standardized Payment Amount | 332189.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 53 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 28414 |
| Total Drug Medicare AllowedAmount | 13426.16 |
| Total Drug Medicare PaymentAmount | 10149.17 |
| Total Drug Medicare Standardized Payment Amount | 10149.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 5133 |
| Number Of Medicare Beneficiaries With Medical Services | 881 |
| Total Medical Submitted Charge Amount | 899954.9 |
| Total Medical Medicare Allowed Amount | 420159.62 |
| Total Medical Medicare Payment Amount | 313305.83 |
| Total Medical Medicare Standardized Payment Amount | 322040.81 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 88 |
| Number Of Beneficiaries Age 65 to 74 | 268 |
| Number Of Beneficiaries Age 75 to 84 | 302 |
| Number Of Beneficiaries Age Greater 84 | 223 |
| Number Of Female Beneficiaries | 549 |
| Number Of Male Beneficiaries | 332 |
| Number Of Non Hispanic White Beneficiaries | 829 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 19 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 728 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 153 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3791 |