| National Provider Identifier [NPI]: | 1033101845 |
| Last Name Of The Provider | JEPPESEN |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | OD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2020 3RD AVE NW |
| Street Address 2 Of The Provider | |
| City Of The Provider | WAVERLY |
| Zip Code Of The Provider | 506772065 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 1336 |
| Number Of Medicare Beneficiaries | 741 |
| Total Submitted Charge Amount | 236630 |
| Total Medicare Allowed Amount | 112091.7 |
| Total Medicare Payment Amount | 71802.51 |
| Total Medicare Standardized Payment Amount | 79769.17 |
| 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 | 20 |
| Number Of Medical Services | 1336 |
| Number Of Medicare Beneficiaries With Medical Services | 741 |
| Total Medical Submitted Charge Amount | 236630 |
| Total Medical Medicare Allowed Amount | 112091.7 |
| Total Medical Medicare Payment Amount | 71802.51 |
| Total Medical Medicare Standardized Payment Amount | 79769.17 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 16 |
| Number Of Beneficiaries Age 65 to 74 | 304 |
| Number Of Beneficiaries Age 75 to 84 | 264 |
| Number Of Beneficiaries Age Greater 84 | 157 |
| Number Of Female Beneficiaries | 473 |
| Number Of Male Beneficiaries | 268 |
| Number Of Non Hispanic White Beneficiaries | 726 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 684 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 2 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9323 |