| National Provider Identifier [NPI]: | 1194922963 |
| Last Name Of The Provider | COOPER |
| First Name Of The Provider | MARION |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2845 TRICOM ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | N CHARLESTON |
| Zip Code Of The Provider | 294069172 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 1889 |
| Number Of Medicare Beneficiaries | 593 |
| Total Submitted Charge Amount | 335111 |
| Total Medicare Allowed Amount | 165400.88 |
| Total Medicare Payment Amount | 114403.31 |
| Total Medicare Standardized Payment Amount | 121875.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 124 |
| Number Of Medicare Beneficiaries With Drug Services | 119 |
| Total Drug Submitted ChargeAmount | 7618 |
| Total Drug Medicare AllowedAmount | 2454.88 |
| Total Drug Medicare PaymentAmount | 2370.13 |
| Total Drug Medicare Standardized Payment Amount | 2370.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 1765 |
| Number Of Medicare Beneficiaries With Medical Services | 593 |
| Total Medical Submitted Charge Amount | 327493 |
| Total Medical Medicare Allowed Amount | 162946 |
| Total Medical Medicare Payment Amount | 112033.18 |
| Total Medical Medicare Standardized Payment Amount | 119505.17 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 237 |
| Number Of Beneficiaries Age 75 to 84 | 162 |
| Number Of Beneficiaries Age Greater 84 | 145 |
| Number Of Female Beneficiaries | 317 |
| Number Of Male Beneficiaries | 276 |
| Number Of Non Hispanic White Beneficiaries | 474 |
| Number Of Black or African American Beneficiaries | 90 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| 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 | 537 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 56 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2451 |