| National Provider Identifier [NPI]: | 1083611958 |
| Last Name Of The Provider | PTACEK |
| First Name Of The Provider | MARK |
| 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 | 555 E JOHN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ONEILL |
| Zip Code Of The Provider | 687631355 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 72 |
| Number Of Services | 853 |
| Number Of Medicare Beneficiaries | 274 |
| Total Submitted Charge Amount | 110251.17 |
| Total Medicare Allowed Amount | 43212.03 |
| Total Medicare Payment Amount | 31243.18 |
| Total Medicare Standardized Payment Amount | 34113.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 72 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 2270.11 |
| Total Drug Medicare AllowedAmount | 1023.03 |
| Total Drug Medicare PaymentAmount | 986.13 |
| Total Drug Medicare Standardized Payment Amount | 986.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 58 |
| Number Of Medical Services | 781 |
| Number Of Medicare Beneficiaries With Medical Services | 274 |
| Total Medical Submitted Charge Amount | 107981.06 |
| Total Medical Medicare Allowed Amount | 42189 |
| Total Medical Medicare Payment Amount | 30257.05 |
| Total Medical Medicare Standardized Payment Amount | 33127.13 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 146 |
| Number Of Beneficiaries Age 65 to 74 | 64 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 144 |
| Number Of Male Beneficiaries | 130 |
| Number Of Non Hispanic White Beneficiaries | 191 |
| Number Of Black or African American Beneficiaries | 62 |
| 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 | 109 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 165 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.794 |