| National Provider Identifier [NPI]: | 1104805498 |
| Last Name Of The Provider | COUNCE |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3276 N NORTHHILLS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FAYETTEVILLE |
| Zip Code Of The Provider | 727034005 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiac Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 755 |
| Number Of Medicare Beneficiaries | 382 |
| Total Submitted Charge Amount | 851377 |
| Total Medicare Allowed Amount | 314134.47 |
| Total Medicare Payment Amount | 245569.5 |
| Total Medicare Standardized Payment Amount | 272510.62 |
| 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 | 104 |
| Number Of Medical Services | 755 |
| Number Of Medicare Beneficiaries With Medical Services | 382 |
| Total Medical Submitted Charge Amount | 851377 |
| Total Medical Medicare Allowed Amount | 314134.47 |
| Total Medical Medicare Payment Amount | 245569.5 |
| Total Medical Medicare Standardized Payment Amount | 272510.62 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 169 |
| Number Of Beneficiaries Age 75 to 84 | 137 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 161 |
| Number Of Male Beneficiaries | 221 |
| Number Of Non Hispanic White Beneficiaries | 355 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 315 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 67 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.811 |