| National Provider Identifier [NPI]: | 1245300565 |
| Last Name Of The Provider | FANDERS |
| First Name Of The Provider | BARRY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6901 N 72ND ST |
| Street Address 2 Of The Provider | ALEGENT IMMANUEL HOSPITAL DEPT OF RADIOLOGY |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681221709 |
| 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 | 192 |
| Number Of Services | 4247 |
| Number Of Medicare Beneficiaries | 2724 |
| Total Submitted Charge Amount | 475765 |
| Total Medicare Allowed Amount | 125030.67 |
| Total Medicare Payment Amount | 94458.04 |
| Total Medicare Standardized Payment Amount | 101102.23 |
| 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 | 192 |
| Number Of Medical Services | 4247 |
| Number Of Medicare Beneficiaries With Medical Services | 2724 |
| Total Medical Submitted Charge Amount | 475765 |
| Total Medical Medicare Allowed Amount | 125030.67 |
| Total Medical Medicare Payment Amount | 94458.04 |
| Total Medical Medicare Standardized Payment Amount | 101102.23 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 465 |
| Number Of Beneficiaries Age 65 to 74 | 956 |
| Number Of Beneficiaries Age 75 to 84 | 795 |
| Number Of Beneficiaries Age Greater 84 | 508 |
| Number Of Female Beneficiaries | 1569 |
| Number Of Male Beneficiaries | 1155 |
| Number Of Non Hispanic White Beneficiaries | 2440 |
| Number Of Black or African American Beneficiaries | 171 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 64 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2075 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 649 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.8421 |