| National Provider Identifier [NPI]: | 1093766107 |
| Last Name Of The Provider | NIETERS |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2753 FOXPOINTE DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 472033224 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 11374 |
| Number Of Medicare Beneficiaries | 581 |
| Total Submitted Charge Amount | 381497.5 |
| Total Medicare Allowed Amount | 221858.84 |
| Total Medicare Payment Amount | 159750.91 |
| Total Medicare Standardized Payment Amount | 170364.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 3676 |
| Number Of Medicare Beneficiaries With Drug Services | 266 |
| Total Drug Submitted ChargeAmount | 60734 |
| Total Drug Medicare AllowedAmount | 21982.15 |
| Total Drug Medicare PaymentAmount | 16810.76 |
| Total Drug Medicare Standardized Payment Amount | 16810.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 66 |
| Number Of Medical Services | 7698 |
| Number Of Medicare Beneficiaries With Medical Services | 581 |
| Total Medical Submitted Charge Amount | 320763.5 |
| Total Medical Medicare Allowed Amount | 199876.69 |
| Total Medical Medicare Payment Amount | 142940.15 |
| Total Medical Medicare Standardized Payment Amount | 153553.89 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 306 |
| Number Of Beneficiaries Age 75 to 84 | 168 |
| Number Of Beneficiaries Age Greater 84 | 53 |
| Number Of Female Beneficiaries | 319 |
| Number Of Male Beneficiaries | 262 |
| Number Of Non Hispanic White Beneficiaries | 561 |
| Number Of Black or African American Beneficiaries | |
| 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 | 541 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8685 |