| National Provider Identifier [NPI]: | 1922028919 |
| Last Name Of The Provider | PROKOP |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 900 BROADWAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | BANGOR |
| Zip Code Of The Provider | 044011900 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 2342 |
| Number Of Medicare Beneficiaries | 594 |
| Total Submitted Charge Amount | 292041.42 |
| Total Medicare Allowed Amount | 159227.25 |
| Total Medicare Payment Amount | 111829.87 |
| Total Medicare Standardized Payment Amount | 119860.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 42 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 873 |
| Total Drug Medicare AllowedAmount | 550.18 |
| Total Drug Medicare PaymentAmount | 538.66 |
| Total Drug Medicare Standardized Payment Amount | 538.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 2300 |
| Number Of Medicare Beneficiaries With Medical Services | 594 |
| Total Medical Submitted Charge Amount | 291168.42 |
| Total Medical Medicare Allowed Amount | 158677.07 |
| Total Medical Medicare Payment Amount | 111291.21 |
| Total Medical Medicare Standardized Payment Amount | 119322.01 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 242 |
| Number Of Beneficiaries Age 75 to 84 | 208 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 315 |
| Number Of Male Beneficiaries | 279 |
| Number Of Non Hispanic White Beneficiaries | 580 |
| Number Of Black or African American Beneficiaries | |
| 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 | 455 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 139 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0979 |