| National Provider Identifier [NPI]: | 1396721965 |
| Last Name Of The Provider | NEBELSIECK |
| First Name Of The Provider | JEFFREY |
| 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 | 4400 N 32ND ST |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | PHOENIX |
| Zip Code Of The Provider | 850183953 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 85 |
| Number Of Services | 13086 |
| Number Of Medicare Beneficiaries | 723 |
| Total Submitted Charge Amount | 366759.96 |
| Total Medicare Allowed Amount | 320403.54 |
| Total Medicare Payment Amount | 245010.44 |
| Total Medicare Standardized Payment Amount | 258264.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 977 |
| Number Of Medicare Beneficiaries With Drug Services | 293 |
| Total Drug Submitted ChargeAmount | 12367.4 |
| Total Drug Medicare AllowedAmount | 8229.69 |
| Total Drug Medicare PaymentAmount | 7844.56 |
| Total Drug Medicare Standardized Payment Amount | 7844.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 77 |
| Number Of Medical Services | 12109 |
| Number Of Medicare Beneficiaries With Medical Services | 723 |
| Total Medical Submitted Charge Amount | 354392.56 |
| Total Medical Medicare Allowed Amount | 312173.85 |
| Total Medical Medicare Payment Amount | 237165.88 |
| Total Medical Medicare Standardized Payment Amount | 250419.52 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 254 |
| Number Of Beneficiaries Age 75 to 84 | 315 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 371 |
| Number Of Male Beneficiaries | 352 |
| Number Of Non Hispanic White Beneficiaries | 699 |
| Number Of Black or African American Beneficiaries | |
| 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 | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.8827 |