| National Provider Identifier [NPI]: | 1629292040 |
| Last Name Of The Provider | KOEHL |
| First Name Of The Provider | EDWARD |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 18697 BAGLEY ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MIDDLEBURG HEIGHTS |
| Zip Code Of The Provider | 441303417 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 265 |
| Number Of Services | 5127 |
| Number Of Medicare Beneficiaries | 2438 |
| Total Submitted Charge Amount | 827664 |
| Total Medicare Allowed Amount | 264008.95 |
| Total Medicare Payment Amount | 201492.17 |
| Total Medicare Standardized Payment Amount | 207769.24 |
| 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 | 265 |
| Number Of Medical Services | 5127 |
| Number Of Medicare Beneficiaries With Medical Services | 2438 |
| Total Medical Submitted Charge Amount | 827664 |
| Total Medical Medicare Allowed Amount | 264008.95 |
| Total Medical Medicare Payment Amount | 201492.17 |
| Total Medical Medicare Standardized Payment Amount | 207769.24 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 278 |
| Number Of Beneficiaries Age 65 to 74 | 848 |
| Number Of Beneficiaries Age 75 to 84 | 854 |
| Number Of Beneficiaries Age Greater 84 | 458 |
| Number Of Female Beneficiaries | 1393 |
| Number Of Male Beneficiaries | 1045 |
| Number Of Non Hispanic White Beneficiaries | 2302 |
| Number Of Black or African American Beneficiaries | 44 |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2089 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 349 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.8235 |