| National Provider Identifier [NPI]: | 1851340657 |
| Last Name Of The Provider | BORMAN |
| First Name Of The Provider | EDWARD |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2501 CAPEHART RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | OFFUTT A F B |
| Zip Code Of The Provider | 681131043 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 175 |
| Number Of Services | 14861 |
| Number Of Medicare Beneficiaries | 3946 |
| Total Submitted Charge Amount | 1949849.5 |
| Total Medicare Allowed Amount | 260450.38 |
| Total Medicare Payment Amount | 201682.36 |
| Total Medicare Standardized Payment Amount | 212077.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 9142 |
| Number Of Medicare Beneficiaries With Drug Services | 121 |
| Total Drug Submitted ChargeAmount | 12014.5 |
| Total Drug Medicare AllowedAmount | 3242.02 |
| Total Drug Medicare PaymentAmount | 2489.03 |
| Total Drug Medicare Standardized Payment Amount | 2489.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 170 |
| Number Of Medical Services | 5719 |
| Number Of Medicare Beneficiaries With Medical Services | 3946 |
| Total Medical Submitted Charge Amount | 1937835 |
| Total Medical Medicare Allowed Amount | 257208.36 |
| Total Medical Medicare Payment Amount | 199193.33 |
| Total Medical Medicare Standardized Payment Amount | 209588.91 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 644 |
| Number Of Beneficiaries Age 65 to 74 | 1579 |
| Number Of Beneficiaries Age 75 to 84 | 1111 |
| Number Of Beneficiaries Age Greater 84 | 612 |
| Number Of Female Beneficiaries | 2522 |
| Number Of Male Beneficiaries | 1424 |
| Number Of Non Hispanic White Beneficiaries | 3700 |
| Number Of Black or African American Beneficiaries | 92 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 56 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 48 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3164 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 782 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2688 |