| National Provider Identifier [NPI]: | 1487622551 |
| Last Name Of The Provider | FREIDEL |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 204 BRIDGEWAY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | AURORA |
| Zip Code Of The Provider | 470011334 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 98 |
| Number Of Services | 4390 |
| Number Of Medicare Beneficiaries | 441 |
| Total Submitted Charge Amount | 378997.8 |
| Total Medicare Allowed Amount | 235489.67 |
| Total Medicare Payment Amount | 161954.42 |
| Total Medicare Standardized Payment Amount | 175457.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 827 |
| Number Of Medicare Beneficiaries With Drug Services | 244 |
| Total Drug Submitted ChargeAmount | 22206.8 |
| Total Drug Medicare AllowedAmount | 12993.24 |
| Total Drug Medicare PaymentAmount | 11509.2 |
| Total Drug Medicare Standardized Payment Amount | 11509.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 3563 |
| Number Of Medicare Beneficiaries With Medical Services | 441 |
| Total Medical Submitted Charge Amount | 356791 |
| Total Medical Medicare Allowed Amount | 222496.43 |
| Total Medical Medicare Payment Amount | 150445.22 |
| Total Medical Medicare Standardized Payment Amount | 163948.61 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 74 |
| Number Of Beneficiaries Age 65 to 74 | 187 |
| Number Of Beneficiaries Age 75 to 84 | 135 |
| Number Of Beneficiaries Age Greater 84 | 45 |
| Number Of Female Beneficiaries | 243 |
| Number Of Male Beneficiaries | 198 |
| Number Of Non Hispanic White Beneficiaries | 424 |
| Number Of Black or African American Beneficiaries | |
| 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 | 352 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 89 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9239 |