| National Provider Identifier [NPI]: | 1831161587 |
| Last Name Of The Provider | STAACK |
| First Name Of The Provider | KAREN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1130 N 204TH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ELKHORN |
| Zip Code Of The Provider | 680221849 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 1262 |
| Number Of Medicare Beneficiaries | 180 |
| Total Submitted Charge Amount | 102899.2 |
| Total Medicare Allowed Amount | 49412.23 |
| Total Medicare Payment Amount | 34984.9 |
| Total Medicare Standardized Payment Amount | 37996.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 150 |
| Number Of Medicare Beneficiaries With Drug Services | 74 |
| Total Drug Submitted ChargeAmount | 7512.2 |
| Total Drug Medicare AllowedAmount | 4136.07 |
| Total Drug Medicare PaymentAmount | 4038.52 |
| Total Drug Medicare Standardized Payment Amount | 4038.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 1112 |
| Number Of Medicare Beneficiaries With Medical Services | 180 |
| Total Medical Submitted Charge Amount | 95387 |
| Total Medical Medicare Allowed Amount | 45276.16 |
| Total Medical Medicare Payment Amount | 30946.38 |
| Total Medical Medicare Standardized Payment Amount | 33957.74 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 99 |
| Number Of Beneficiaries Age 75 to 84 | 39 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 138 |
| Number Of Male Beneficiaries | 42 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 163 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8686 |