| National Provider Identifier [NPI]: | 1023078037 |
| Last Name Of The Provider | COOPER |
| First Name Of The Provider | WILLIAM |
| 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 | 1185 CORPORATE CENTER DR STE 175 |
| Street Address 2 Of The Provider | PROHEALTH CARE MEDICAL ASSOCIATES INC. |
| City Of The Provider | OCONOMOWOC |
| Zip Code Of The Provider | 530664889 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 3426 |
| Number Of Medicare Beneficiaries | 745 |
| Total Submitted Charge Amount | 505366 |
| Total Medicare Allowed Amount | 218477.78 |
| Total Medicare Payment Amount | 156997.49 |
| Total Medicare Standardized Payment Amount | 164132.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 185 |
| Number Of Medicare Beneficiaries With Drug Services | 168 |
| Total Drug Submitted ChargeAmount | 9343 |
| Total Drug Medicare AllowedAmount | 7286.1 |
| Total Drug Medicare PaymentAmount | 7131.3 |
| Total Drug Medicare Standardized Payment Amount | 7131.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 3241 |
| Number Of Medicare Beneficiaries With Medical Services | 744 |
| Total Medical Submitted Charge Amount | 496023 |
| Total Medical Medicare Allowed Amount | 211191.68 |
| Total Medical Medicare Payment Amount | 149866.19 |
| Total Medical Medicare Standardized Payment Amount | 157001.6 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 240 |
| Number Of Beneficiaries Age 75 to 84 | 221 |
| Number Of Beneficiaries Age Greater 84 | 242 |
| Number Of Female Beneficiaries | 420 |
| Number Of Male Beneficiaries | 325 |
| Number Of Non Hispanic White Beneficiaries | 731 |
| 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 | 670 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3028 |