| National Provider Identifier [NPI]: | 1336196674 |
| Last Name Of The Provider | VERNON |
| First Name Of The Provider | JUAN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 593 EDDY STREET SAMUELS BLDG |
| Street Address 2 Of The Provider | RHODE ISLAND HOSPITAL |
| City Of The Provider | PROVIDENCE |
| Zip Code Of The Provider | 02903 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 977 |
| Number Of Medicare Beneficiaries | 701 |
| Total Submitted Charge Amount | 343439 |
| Total Medicare Allowed Amount | 111961.13 |
| Total Medicare Payment Amount | 86169.43 |
| Total Medicare Standardized Payment Amount | 86078.8 |
| 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 | 41 |
| Number Of Medical Services | 977 |
| Number Of Medicare Beneficiaries With Medical Services | 701 |
| Total Medical Submitted Charge Amount | 343439 |
| Total Medical Medicare Allowed Amount | 111961.13 |
| Total Medical Medicare Payment Amount | 86169.43 |
| Total Medical Medicare Standardized Payment Amount | 86078.8 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 320 |
| Number Of Beneficiaries Age 65 to 74 | 168 |
| Number Of Beneficiaries Age 75 to 84 | 117 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 338 |
| Number Of Male Beneficiaries | 363 |
| Number Of Non Hispanic White Beneficiaries | 570 |
| Number Of Black or African American Beneficiaries | 30 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 77 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 291 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 410 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 53 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 20 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.927 |