| National Provider Identifier [NPI]: | 1962480574 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5308 PARKLANE DRIVE |
| Street Address 2 Of The Provider | SUITE 4B |
| City Of The Provider | KEARNEY |
| Zip Code Of The Provider | 688478629 |
| 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 | 201 |
| Number Of Services | 10115 |
| Number Of Medicare Beneficiaries | 5529 |
| Total Submitted Charge Amount | 706649 |
| Total Medicare Allowed Amount | 246151.13 |
| Total Medicare Payment Amount | 188931.79 |
| Total Medicare Standardized Payment Amount | 201313.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 201 |
| Number Of Medical Services | 10115 |
| Number Of Medicare Beneficiaries With Medical Services | 5529 |
| Total Medical Submitted Charge Amount | 706649 |
| Total Medical Medicare Allowed Amount | 246151.13 |
| Total Medical Medicare Payment Amount | 188931.79 |
| Total Medical Medicare Standardized Payment Amount | 201313.46 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 633 |
| Number Of Beneficiaries Age 65 to 74 | 1883 |
| Number Of Beneficiaries Age 75 to 84 | 1774 |
| Number Of Beneficiaries Age Greater 84 | 1239 |
| Number Of Female Beneficiaries | 3611 |
| Number Of Male Beneficiaries | 1918 |
| Number Of Non Hispanic White Beneficiaries | 5285 |
| Number Of Black or African American Beneficiaries | 24 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 156 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4456 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1073 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| 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 | 27 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2185 |