| National Provider Identifier [NPI]: | 1578707113 |
| Last Name Of The Provider | EVANS |
| First Name Of The Provider | CODY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3821 MARCY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681051801 |
| 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 | 311 |
| Number Of Services | 8222 |
| Number Of Medicare Beneficiaries | 2986 |
| Total Submitted Charge Amount | 1920165.5 |
| Total Medicare Allowed Amount | 357608.78 |
| Total Medicare Payment Amount | 273356.68 |
| Total Medicare Standardized Payment Amount | 291163.55 |
| 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 | 311 |
| Number Of Medical Services | 8222 |
| Number Of Medicare Beneficiaries With Medical Services | 2986 |
| Total Medical Submitted Charge Amount | 1920165.5 |
| Total Medical Medicare Allowed Amount | 357608.78 |
| Total Medical Medicare Payment Amount | 273356.68 |
| Total Medical Medicare Standardized Payment Amount | 291163.55 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 425 |
| Number Of Beneficiaries Age 65 to 74 | 922 |
| Number Of Beneficiaries Age 75 to 84 | 980 |
| Number Of Beneficiaries Age Greater 84 | 659 |
| Number Of Female Beneficiaries | 1742 |
| Number Of Male Beneficiaries | 1244 |
| Number Of Non Hispanic White Beneficiaries | 2846 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 101 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2296 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 690 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6308 |