| National Provider Identifier [NPI]: | 1922058437 |
| Last Name Of The Provider | KOOSTRA |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 30 GARDEN CT |
| Street Address 2 Of The Provider | |
| City Of The Provider | MONTEREY |
| Zip Code Of The Provider | 939405302 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 3574 |
| Number Of Medicare Beneficiaries | 1002 |
| Total Submitted Charge Amount | 499798.87 |
| Total Medicare Allowed Amount | 278590.95 |
| Total Medicare Payment Amount | 209713.67 |
| Total Medicare Standardized Payment Amount | 202087.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 112 |
| Number Of Medicare Beneficiaries With Drug Services | 74 |
| Total Drug Submitted ChargeAmount | 1405.35 |
| Total Drug Medicare AllowedAmount | 852.23 |
| Total Drug Medicare PaymentAmount | 702.89 |
| Total Drug Medicare Standardized Payment Amount | 702.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 3462 |
| Number Of Medicare Beneficiaries With Medical Services | 1002 |
| Total Medical Submitted Charge Amount | 498393.52 |
| Total Medical Medicare Allowed Amount | 277738.72 |
| Total Medical Medicare Payment Amount | 209010.78 |
| Total Medical Medicare Standardized Payment Amount | 201384.23 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 95 |
| Number Of Beneficiaries Age 65 to 74 | 331 |
| Number Of Beneficiaries Age 75 to 84 | 360 |
| Number Of Beneficiaries Age Greater 84 | 216 |
| Number Of Female Beneficiaries | 564 |
| Number Of Male Beneficiaries | 438 |
| Number Of Non Hispanic White Beneficiaries | 788 |
| Number Of Black or African American Beneficiaries | 52 |
| Number Of AsianPacific Islander Beneficiaries | 65 |
| Number Of Hispanic Beneficiaries | 70 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 834 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 168 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 29 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 44 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.607 |