| National Provider Identifier [NPI]: | 1558326793 |
| Last Name Of The Provider | FEUTZ |
| First Name Of The Provider | EDWARD |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 818 E BROADWAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPARTA |
| Zip Code Of The Provider | 62288 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 158 |
| Number Of Services | 4384 |
| Number Of Medicare Beneficiaries | 2191 |
| Total Submitted Charge Amount | 419853 |
| Total Medicare Allowed Amount | 139852.47 |
| Total Medicare Payment Amount | 105964.8 |
| Total Medicare Standardized Payment Amount | 105511.45 |
| 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 | 158 |
| Number Of Medical Services | 4384 |
| Number Of Medicare Beneficiaries With Medical Services | 2191 |
| Total Medical Submitted Charge Amount | 419853 |
| Total Medical Medicare Allowed Amount | 139852.47 |
| Total Medical Medicare Payment Amount | 105964.8 |
| Total Medical Medicare Standardized Payment Amount | 105511.45 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 330 |
| Number Of Beneficiaries Age 65 to 74 | 795 |
| Number Of Beneficiaries Age 75 to 84 | 688 |
| Number Of Beneficiaries Age Greater 84 | 378 |
| Number Of Female Beneficiaries | 1347 |
| Number Of Male Beneficiaries | 844 |
| Number Of Non Hispanic White Beneficiaries | 2107 |
| Number Of Black or African American Beneficiaries | 53 |
| 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 | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1762 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 429 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2014 |