| National Provider Identifier [NPI]: | 1093763252 |
| Last Name Of The Provider | KOPTIK |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2332 ALPINE AVE NW |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495441955 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 428 |
| Number Of Medicare Beneficiaries | 204 |
| Total Submitted Charge Amount | 44432 |
| Total Medicare Allowed Amount | 18668.82 |
| Total Medicare Payment Amount | 12592.58 |
| Total Medicare Standardized Payment Amount | 13786.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 73 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 1026 |
| Total Drug Medicare AllowedAmount | 804.3 |
| Total Drug Medicare PaymentAmount | 521.9 |
| Total Drug Medicare Standardized Payment Amount | 521.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 355 |
| Number Of Medicare Beneficiaries With Medical Services | 204 |
| Total Medical Submitted Charge Amount | 43406 |
| Total Medical Medicare Allowed Amount | 17864.52 |
| Total Medical Medicare Payment Amount | 12070.68 |
| Total Medical Medicare Standardized Payment Amount | 13264.5 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 96 |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 125 |
| Number Of Male Beneficiaries | 79 |
| Number Of Non Hispanic White Beneficiaries | 169 |
| Number Of Black or African American Beneficiaries | 21 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 117 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 87 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2098 |