| National Provider Identifier [NPI]: | 1861466583 |
| Last Name Of The Provider | BERGEN |
| First Name Of The Provider | RANDALL |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 505 5TH ST |
| Street Address 2 Of The Provider | SUITE 714 |
| City Of The Provider | SIOUX CITY |
| Zip Code Of The Provider | 511011500 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 3663 |
| Number Of Medicare Beneficiaries | 1189 |
| Total Submitted Charge Amount | 195998 |
| Total Medicare Allowed Amount | 148988.95 |
| Total Medicare Payment Amount | 90910.25 |
| Total Medicare Standardized Payment Amount | 109535.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 71 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 568 |
| Total Drug Medicare AllowedAmount | 407.36 |
| Total Drug Medicare PaymentAmount | 283.11 |
| Total Drug Medicare Standardized Payment Amount | 283.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 3592 |
| Number Of Medicare Beneficiaries With Medical Services | 1189 |
| Total Medical Submitted Charge Amount | 195430 |
| Total Medical Medicare Allowed Amount | 148581.59 |
| Total Medical Medicare Payment Amount | 90627.14 |
| Total Medical Medicare Standardized Payment Amount | 109251.98 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 132 |
| Number Of Beneficiaries Age 65 to 74 | 223 |
| Number Of Beneficiaries Age 75 to 84 | 317 |
| Number Of Beneficiaries Age Greater 84 | 517 |
| Number Of Female Beneficiaries | 775 |
| Number Of Male Beneficiaries | 414 |
| Number Of Non Hispanic White Beneficiaries | 1155 |
| Number Of Black or African American Beneficiaries | 11 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 12 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 742 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 447 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 38 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6237 |