| National Provider Identifier [NPI]: | 1629053756 |
| Last Name Of The Provider | FYE |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 225 S PINE ST |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | SEYMOUR |
| Zip Code Of The Provider | 472742365 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 4063 |
| Number Of Medicare Beneficiaries | 533 |
| Total Submitted Charge Amount | 371335 |
| Total Medicare Allowed Amount | 182902.51 |
| Total Medicare Payment Amount | 133095.84 |
| Total Medicare Standardized Payment Amount | 139131.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 225 |
| Number Of Medicare Beneficiaries With Drug Services | 181 |
| Total Drug Submitted ChargeAmount | 9083 |
| Total Drug Medicare AllowedAmount | 6840.4 |
| Total Drug Medicare PaymentAmount | 6558.38 |
| Total Drug Medicare Standardized Payment Amount | 6558.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 3838 |
| Number Of Medicare Beneficiaries With Medical Services | 533 |
| Total Medical Submitted Charge Amount | 362252 |
| Total Medical Medicare Allowed Amount | 176062.11 |
| Total Medical Medicare Payment Amount | 126537.46 |
| Total Medical Medicare Standardized Payment Amount | 132572.96 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 242 |
| Number Of Beneficiaries Age 75 to 84 | 154 |
| Number Of Beneficiaries Age Greater 84 | 83 |
| Number Of Female Beneficiaries | 308 |
| Number Of Male Beneficiaries | 225 |
| 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 | 467 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 66 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1128 |