| National Provider Identifier [NPI]: | 1285675967 |
| Last Name Of The Provider | KOEPSELL |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2829 GLENWOOD AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROCKFORD |
| Zip Code Of The Provider | 611013542 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 1935 |
| Number Of Medicare Beneficiaries | 334 |
| Total Submitted Charge Amount | 190986 |
| Total Medicare Allowed Amount | 157763.97 |
| Total Medicare Payment Amount | 116440.59 |
| Total Medicare Standardized Payment Amount | 122816.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 119 |
| Number Of Medicare Beneficiaries With Drug Services | 84 |
| Total Drug Submitted ChargeAmount | 6475 |
| Total Drug Medicare AllowedAmount | 2718.59 |
| Total Drug Medicare PaymentAmount | 2594.88 |
| Total Drug Medicare Standardized Payment Amount | 2594.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 1816 |
| Number Of Medicare Beneficiaries With Medical Services | 334 |
| Total Medical Submitted Charge Amount | 184511 |
| Total Medical Medicare Allowed Amount | 155045.38 |
| Total Medical Medicare Payment Amount | 113845.71 |
| Total Medical Medicare Standardized Payment Amount | 120221.89 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 107 |
| Number Of Beneficiaries Age 75 to 84 | 107 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 203 |
| Number Of Male Beneficiaries | 131 |
| Number Of Non Hispanic White Beneficiaries | 311 |
| Number Of Black or African American Beneficiaries | 12 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 303 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0812 |