| National Provider Identifier [NPI]: | 1710923826 |
| Last Name Of The Provider | HAGGSTROM |
| First Name Of The Provider | JOHN |
| 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 | 16901 LAKESIDE HILLS CT |
| Street Address 2 Of The Provider | ALEGENT LAKESIDE HOSPITAL DEPT OF RADIOLOGY |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681302318 |
| 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 | 173 |
| Number Of Services | 7040 |
| Number Of Medicare Beneficiaries | 4615 |
| Total Submitted Charge Amount | 957072 |
| Total Medicare Allowed Amount | 253315.07 |
| Total Medicare Payment Amount | 191186.15 |
| Total Medicare Standardized Payment Amount | 205178.18 |
| 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 | 173 |
| Number Of Medical Services | 7040 |
| Number Of Medicare Beneficiaries With Medical Services | 4615 |
| Total Medical Submitted Charge Amount | 957072 |
| Total Medical Medicare Allowed Amount | 253315.07 |
| Total Medical Medicare Payment Amount | 191186.15 |
| Total Medical Medicare Standardized Payment Amount | 205178.18 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 778 |
| Number Of Beneficiaries Age 65 to 74 | 1669 |
| Number Of Beneficiaries Age 75 to 84 | 1332 |
| Number Of Beneficiaries Age Greater 84 | 836 |
| Number Of Female Beneficiaries | 2773 |
| Number Of Male Beneficiaries | 1842 |
| Number Of Non Hispanic White Beneficiaries | 4172 |
| Number Of Black or African American Beneficiaries | 256 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 91 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | 70 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3632 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 983 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6232 |