| National Provider Identifier [NPI]: | 1962409466 |
| Last Name Of The Provider | STOCKRAHM |
| First Name Of The Provider | JON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1600 E SPRINGHILL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | TERRE HAUTE |
| Zip Code Of The Provider | 478024363 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 5437 |
| Number Of Medicare Beneficiaries | 826 |
| Total Submitted Charge Amount | 447994 |
| Total Medicare Allowed Amount | 271603.58 |
| Total Medicare Payment Amount | 190309.18 |
| Total Medicare Standardized Payment Amount | 202706.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 633 |
| Number Of Medicare Beneficiaries With Drug Services | 303 |
| Total Drug Submitted ChargeAmount | 22628 |
| Total Drug Medicare AllowedAmount | 9834.77 |
| Total Drug Medicare PaymentAmount | 9173.2 |
| Total Drug Medicare Standardized Payment Amount | 9173.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 4804 |
| Number Of Medicare Beneficiaries With Medical Services | 826 |
| Total Medical Submitted Charge Amount | 425366 |
| Total Medical Medicare Allowed Amount | 261768.81 |
| Total Medical Medicare Payment Amount | 181135.98 |
| Total Medical Medicare Standardized Payment Amount | 193533.79 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 295 |
| Number Of Beneficiaries Age 75 to 84 | 253 |
| Number Of Beneficiaries Age Greater 84 | 225 |
| Number Of Female Beneficiaries | 498 |
| Number Of Male Beneficiaries | 328 |
| Number Of Non Hispanic White Beneficiaries | 800 |
| Number Of Black or African American Beneficiaries | 13 |
| 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 | 637 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 189 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 33 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4134 |