| National Provider Identifier [NPI]: | 1730121880 |
| Last Name Of The Provider | VANDERJAGT |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1540 LAKE LANSING RD |
| Street Address 2 Of The Provider | STE 102 |
| City Of The Provider | LANSING |
| Zip Code Of The Provider | 489123756 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 3391 |
| Number Of Medicare Beneficiaries | 565 |
| Total Submitted Charge Amount | 406873.15 |
| Total Medicare Allowed Amount | 238213.96 |
| Total Medicare Payment Amount | 171486.2 |
| Total Medicare Standardized Payment Amount | 177801.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 381 |
| Number Of Medicare Beneficiaries With Drug Services | 170 |
| Total Drug Submitted ChargeAmount | 12271.9 |
| Total Drug Medicare AllowedAmount | 7805.34 |
| Total Drug Medicare PaymentAmount | 6924.11 |
| Total Drug Medicare Standardized Payment Amount | 6924.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 3010 |
| Number Of Medicare Beneficiaries With Medical Services | 565 |
| Total Medical Submitted Charge Amount | 394601.25 |
| Total Medical Medicare Allowed Amount | 230408.62 |
| Total Medical Medicare Payment Amount | 164562.09 |
| Total Medical Medicare Standardized Payment Amount | 170877.39 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 78 |
| Number Of Beneficiaries Age 65 to 74 | 232 |
| Number Of Beneficiaries Age 75 to 84 | 163 |
| Number Of Beneficiaries Age Greater 84 | 92 |
| Number Of Female Beneficiaries | 293 |
| Number Of Male Beneficiaries | 272 |
| Number Of Non Hispanic White Beneficiaries | 479 |
| Number Of Black or African American Beneficiaries | 53 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 497 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4055 |