| National Provider Identifier [NPI]: | 1487679270 |
| Last Name Of The Provider | DEPERSIO |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1007 LINCOLNWAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAPORTE |
| Zip Code Of The Provider | 463502301 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 170 |
| Number Of Services | 6482 |
| Number Of Medicare Beneficiaries | 3797 |
| Total Submitted Charge Amount | 539640 |
| Total Medicare Allowed Amount | 149045.23 |
| Total Medicare Payment Amount | 116942.2 |
| Total Medicare Standardized Payment Amount | 123413.19 |
| 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 | 170 |
| Number Of Medical Services | 6482 |
| Number Of Medicare Beneficiaries With Medical Services | 3797 |
| Total Medical Submitted Charge Amount | 539640 |
| Total Medical Medicare Allowed Amount | 149045.23 |
| Total Medical Medicare Payment Amount | 116942.2 |
| Total Medical Medicare Standardized Payment Amount | 123413.19 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 787 |
| Number Of Beneficiaries Age 65 to 74 | 1537 |
| Number Of Beneficiaries Age 75 to 84 | 1003 |
| Number Of Beneficiaries Age Greater 84 | 470 |
| Number Of Female Beneficiaries | 2399 |
| Number Of Male Beneficiaries | 1398 |
| Number Of Non Hispanic White Beneficiaries | 3598 |
| Number Of Black or African American Beneficiaries | 80 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 62 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2845 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 952 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3364 |