| National Provider Identifier [NPI]: | 1689672040 |
| Last Name Of The Provider | KUKULKA |
| First Name Of The Provider | RICK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 601 W LEOTA ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NORTH PLATTE |
| Zip Code Of The Provider | 691016525 |
| 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 | 223 |
| Number Of Services | 14584 |
| Number Of Medicare Beneficiaries | 5754 |
| Total Submitted Charge Amount | 2896757 |
| Total Medicare Allowed Amount | 457001.35 |
| Total Medicare Payment Amount | 351046.06 |
| Total Medicare Standardized Payment Amount | 376941.18 |
| 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 | 223 |
| Number Of Medical Services | 14584 |
| Number Of Medicare Beneficiaries With Medical Services | 5754 |
| Total Medical Submitted Charge Amount | 2896757 |
| Total Medical Medicare Allowed Amount | 457001.35 |
| Total Medical Medicare Payment Amount | 351046.06 |
| Total Medical Medicare Standardized Payment Amount | 376941.18 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 749 |
| Number Of Beneficiaries Age 65 to 74 | 2185 |
| Number Of Beneficiaries Age 75 to 84 | 1830 |
| Number Of Beneficiaries Age Greater 84 | 990 |
| Number Of Female Beneficiaries | 3486 |
| Number Of Male Beneficiaries | 2268 |
| Number Of Non Hispanic White Beneficiaries | 5515 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | 135 |
| Number Of American Indian Alaska Native Beneficiaries | 34 |
| Number Of Beneficiaries With Race Not Else where Classified | 43 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4693 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1061 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3134 |