| National Provider Identifier [NPI]: | 1730183591 |
| Last Name Of The Provider | SELL |
| First Name Of The Provider | JERRY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 506 S MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROCKFORD |
| Zip Code Of The Provider | 458829228 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 126 |
| Number Of Services | 2923 |
| Number Of Medicare Beneficiaries | 307 |
| Total Submitted Charge Amount | 213137 |
| Total Medicare Allowed Amount | 168338.76 |
| Total Medicare Payment Amount | 118327.47 |
| Total Medicare Standardized Payment Amount | 124118 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 415 |
| Number Of Medicare Beneficiaries With Drug Services | 167 |
| Total Drug Submitted ChargeAmount | 6343 |
| Total Drug Medicare AllowedAmount | 3898.01 |
| Total Drug Medicare PaymentAmount | 3620.11 |
| Total Drug Medicare Standardized Payment Amount | 3620.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 114 |
| Number Of Medical Services | 2508 |
| Number Of Medicare Beneficiaries With Medical Services | 307 |
| Total Medical Submitted Charge Amount | 206794 |
| Total Medical Medicare Allowed Amount | 164440.75 |
| Total Medical Medicare Payment Amount | 114707.36 |
| Total Medical Medicare Standardized Payment Amount | 120497.89 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 128 |
| Number Of Beneficiaries Age 75 to 84 | 102 |
| Number Of Beneficiaries Age Greater 84 | 54 |
| Number Of Female Beneficiaries | 176 |
| Number Of Male Beneficiaries | 131 |
| 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 | 283 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0211 |