| National Provider Identifier [NPI]: | 1205848058 |
| Last Name Of The Provider | COOP |
| First Name Of The Provider | FREDERICK |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1530 PINE GROVE AVE |
| Street Address 2 Of The Provider | SUITE 7 |
| City Of The Provider | PORT HURON |
| Zip Code Of The Provider | 48060 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 178 |
| Number Of Services | 4934 |
| Number Of Medicare Beneficiaries | 2908 |
| Total Submitted Charge Amount | 497138 |
| Total Medicare Allowed Amount | 140304.17 |
| Total Medicare Payment Amount | 105323.64 |
| Total Medicare Standardized Payment Amount | 109433.55 |
| 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 | 178 |
| Number Of Medical Services | 4934 |
| Number Of Medicare Beneficiaries With Medical Services | 2908 |
| Total Medical Submitted Charge Amount | 497138 |
| Total Medical Medicare Allowed Amount | 140304.17 |
| Total Medical Medicare Payment Amount | 105323.64 |
| Total Medical Medicare Standardized Payment Amount | 109433.55 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 637 |
| Number Of Beneficiaries Age 65 to 74 | 1074 |
| Number Of Beneficiaries Age 75 to 84 | 767 |
| Number Of Beneficiaries Age Greater 84 | 430 |
| Number Of Female Beneficiaries | 1816 |
| Number Of Male Beneficiaries | 1092 |
| Number Of Non Hispanic White Beneficiaries | 2755 |
| Number Of Black or African American Beneficiaries | 69 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 52 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2087 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 821 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.6714 |