| National Provider Identifier [NPI]: | 1114009149 |
| Last Name Of The Provider | LOPEZ |
| First Name Of The Provider | JOSE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 155 E MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ORLEANS |
| Zip Code Of The Provider | 47452 |
| 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 | 71 |
| Number Of Services | 2316 |
| Number Of Medicare Beneficiaries | 448 |
| Total Submitted Charge Amount | 168876 |
| Total Medicare Allowed Amount | 154065.89 |
| Total Medicare Payment Amount | 112183.25 |
| Total Medicare Standardized Payment Amount | 119400.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 327 |
| Number Of Medicare Beneficiaries With Drug Services | 192 |
| Total Drug Submitted ChargeAmount | 9781 |
| Total Drug Medicare AllowedAmount | 7325.14 |
| Total Drug Medicare PaymentAmount | 7015.09 |
| Total Drug Medicare Standardized Payment Amount | 7015.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 1989 |
| Number Of Medicare Beneficiaries With Medical Services | 448 |
| Total Medical Submitted Charge Amount | 159095 |
| Total Medical Medicare Allowed Amount | 146740.75 |
| Total Medical Medicare Payment Amount | 105168.16 |
| Total Medical Medicare Standardized Payment Amount | 112385.7 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 192 |
| Number Of Beneficiaries Age 75 to 84 | 148 |
| Number Of Beneficiaries Age Greater 84 | 56 |
| Number Of Female Beneficiaries | 233 |
| Number Of Male Beneficiaries | 215 |
| 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 | 326 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 122 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.997 |