| National Provider Identifier [NPI]: | 1700875515 |
| Last Name Of The Provider | JACOBY |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1125 E SOUTHERN AVE |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | MESA |
| Zip Code Of The Provider | 852045045 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 305 |
| Number Of Services | 8601 |
| Number Of Medicare Beneficiaries | 3181 |
| Total Submitted Charge Amount | 836011.22 |
| Total Medicare Allowed Amount | 238712.68 |
| Total Medicare Payment Amount | 180139.39 |
| Total Medicare Standardized Payment Amount | 183719.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 3565 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 6817 |
| Total Drug Medicare AllowedAmount | 714.39 |
| Total Drug Medicare PaymentAmount | 560.06 |
| Total Drug Medicare Standardized Payment Amount | 560.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 304 |
| Number Of Medical Services | 5036 |
| Number Of Medicare Beneficiaries With Medical Services | 3181 |
| Total Medical Submitted Charge Amount | 829194.22 |
| Total Medical Medicare Allowed Amount | 237998.29 |
| Total Medical Medicare Payment Amount | 179579.33 |
| Total Medical Medicare Standardized Payment Amount | 183159.04 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 430 |
| Number Of Beneficiaries Age 65 to 74 | 1171 |
| Number Of Beneficiaries Age 75 to 84 | 978 |
| Number Of Beneficiaries Age Greater 84 | 602 |
| Number Of Female Beneficiaries | 1712 |
| Number Of Male Beneficiaries | 1469 |
| Number Of Non Hispanic White Beneficiaries | 2639 |
| Number Of Black or African American Beneficiaries | 126 |
| Number Of AsianPacific Islander Beneficiaries | 46 |
| Number Of Hispanic Beneficiaries | 222 |
| Number Of American Indian Alaska Native Beneficiaries | 103 |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2637 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 544 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0679 |