| National Provider Identifier [NPI]: | 1114921525 |
| Last Name Of The Provider | LUCKASEN |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4242 FARNAM ST |
| Street Address 2 Of The Provider | STE 360 |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681312850 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 21810 |
| Number Of Medicare Beneficiaries | 2685 |
| Total Submitted Charge Amount | 3163286 |
| Total Medicare Allowed Amount | 1101717.47 |
| Total Medicare Payment Amount | 797194.8 |
| Total Medicare Standardized Payment Amount | 726220.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1606 |
| Number Of Medicare Beneficiaries With Drug Services | 305 |
| Total Drug Submitted ChargeAmount | 9636 |
| Total Drug Medicare AllowedAmount | 2861.89 |
| Total Drug Medicare PaymentAmount | 2029.84 |
| Total Drug Medicare Standardized Payment Amount | 2029.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 90 |
| Number Of Medical Services | 20204 |
| Number Of Medicare Beneficiaries With Medical Services | 2685 |
| Total Medical Submitted Charge Amount | 3153650 |
| Total Medical Medicare Allowed Amount | 1098855.58 |
| Total Medical Medicare Payment Amount | 795164.96 |
| Total Medical Medicare Standardized Payment Amount | 724190.84 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 210 |
| Number Of Beneficiaries Age 65 to 74 | 1166 |
| Number Of Beneficiaries Age 75 to 84 | 921 |
| Number Of Beneficiaries Age Greater 84 | 388 |
| Number Of Female Beneficiaries | 1283 |
| Number Of Male Beneficiaries | 1402 |
| Number Of Non Hispanic White Beneficiaries | 2533 |
| Number Of Black or African American Beneficiaries | 69 |
| 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 | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2468 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 217 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.993 |