| National Provider Identifier [NPI]: | 1023076874 |
| Last Name Of The Provider | LAKE |
| First Name Of The Provider | LADD |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 501 N 87TH ST |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681142881 |
| 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 | 289 |
| Number Of Services | 7752 |
| Number Of Medicare Beneficiaries | 4260 |
| Total Submitted Charge Amount | 1592983 |
| Total Medicare Allowed Amount | 289859.59 |
| Total Medicare Payment Amount | 228970.07 |
| Total Medicare Standardized Payment Amount | 245051.63 |
| 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 | 289 |
| Number Of Medical Services | 7752 |
| Number Of Medicare Beneficiaries With Medical Services | 4260 |
| Total Medical Submitted Charge Amount | 1592983 |
| Total Medical Medicare Allowed Amount | 289859.59 |
| Total Medical Medicare Payment Amount | 228970.07 |
| Total Medical Medicare Standardized Payment Amount | 245051.63 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 563 |
| Number Of Beneficiaries Age 65 to 74 | 1576 |
| Number Of Beneficiaries Age 75 to 84 | 1413 |
| Number Of Beneficiaries Age Greater 84 | 708 |
| Number Of Female Beneficiaries | 2654 |
| Number Of Male Beneficiaries | 1606 |
| Number Of Non Hispanic White Beneficiaries | 4056 |
| Number Of Black or African American Beneficiaries | 34 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 87 |
| Number Of American Indian Alaska Native Beneficiaries | 30 |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3409 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 851 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4261 |