| National Provider Identifier [NPI]: | 1578579249 |
| Last Name Of The Provider | BLOCK |
| First Name Of The Provider | DALE |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4TH AND PONCA |
| Street Address 2 Of The Provider | 101 MAIN ST |
| City Of The Provider | LYNCH |
| Zip Code Of The Provider | 68746 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 2532 |
| Number Of Medicare Beneficiaries | 191 |
| Total Submitted Charge Amount | 54260.71 |
| Total Medicare Allowed Amount | 48798.1 |
| Total Medicare Payment Amount | 33048.52 |
| Total Medicare Standardized Payment Amount | 36620.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 1703 |
| Number Of Medicare Beneficiaries With Drug Services | 142 |
| Total Drug Submitted ChargeAmount | 8396.51 |
| Total Drug Medicare AllowedAmount | 4632.58 |
| Total Drug Medicare PaymentAmount | 3478.15 |
| Total Drug Medicare Standardized Payment Amount | 3478.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 829 |
| Number Of Medicare Beneficiaries With Medical Services | 191 |
| Total Medical Submitted Charge Amount | 45864.2 |
| Total Medical Medicare Allowed Amount | 44165.52 |
| Total Medical Medicare Payment Amount | 29570.37 |
| Total Medical Medicare Standardized Payment Amount | 33142.7 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 79 |
| Number Of Beneficiaries Age 75 to 84 | 56 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 96 |
| Number Of Male Beneficiaries | 95 |
| 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 | 176 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9679 |