| National Provider Identifier [NPI]: | 1184675431 |
| Last Name Of The Provider | KOPP |
| First Name Of The Provider | TERRY |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11725 STINSON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHISAGO CITY |
| Zip Code Of The Provider | 550139542 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 620 |
| Number Of Medicare Beneficiaries | 200 |
| Total Submitted Charge Amount | 79680.78 |
| Total Medicare Allowed Amount | 35437.19 |
| Total Medicare Payment Amount | 24054.8 |
| Total Medicare Standardized Payment Amount | 25410.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 67 |
| Number Of Medicare Beneficiaries With Drug Services | 53 |
| Total Drug Submitted ChargeAmount | 2385.78 |
| Total Drug Medicare AllowedAmount | 2087.9 |
| Total Drug Medicare PaymentAmount | 1950.43 |
| Total Drug Medicare Standardized Payment Amount | 1950.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 553 |
| Number Of Medicare Beneficiaries With Medical Services | 199 |
| Total Medical Submitted Charge Amount | 77295 |
| Total Medical Medicare Allowed Amount | 33349.29 |
| Total Medical Medicare Payment Amount | 22104.37 |
| Total Medical Medicare Standardized Payment Amount | 23459.66 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 63 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 81 |
| Number Of Male Beneficiaries | 119 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 151 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1813 |