| National Provider Identifier [NPI]: | 1730102575 |
| Last Name Of The Provider | COPPOLA |
| First Name Of The Provider | NICHOLAS |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1300 36TH ST |
| Street Address 2 Of The Provider | SUITE G |
| City Of The Provider | VERO BEACH |
| Zip Code Of The Provider | 329604898 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 1608 |
| Number Of Medicare Beneficiaries | 309 |
| Total Submitted Charge Amount | 131838.03 |
| Total Medicare Allowed Amount | 88864.2 |
| Total Medicare Payment Amount | 61002.94 |
| Total Medicare Standardized Payment Amount | 60172.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 91 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 1607.5 |
| Total Drug Medicare AllowedAmount | 865.93 |
| Total Drug Medicare PaymentAmount | 833.85 |
| Total Drug Medicare Standardized Payment Amount | 833.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 1517 |
| Number Of Medicare Beneficiaries With Medical Services | 309 |
| Total Medical Submitted Charge Amount | 130230.53 |
| Total Medical Medicare Allowed Amount | 87998.27 |
| Total Medical Medicare Payment Amount | 60169.09 |
| Total Medical Medicare Standardized Payment Amount | 59338.57 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 147 |
| Number Of Beneficiaries Age 75 to 84 | 81 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 181 |
| Number Of Male Beneficiaries | 128 |
| Number Of Non Hispanic White Beneficiaries | 275 |
| Number Of Black or African American Beneficiaries | 21 |
| 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 | 252 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1306 |