| National Provider Identifier [NPI]: | 1497803654 |
| Last Name Of The Provider | FAULK |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7950 HARRISON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAVISTA |
| Zip Code Of The Provider | 681282912 |
| 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 | 198 |
| Number Of Services | 10361 |
| Number Of Medicare Beneficiaries | 3706 |
| Total Submitted Charge Amount | 1607296 |
| Total Medicare Allowed Amount | 303262.16 |
| Total Medicare Payment Amount | 258868.83 |
| Total Medicare Standardized Payment Amount | 278194.45 |
| 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 | 198 |
| Number Of Medical Services | 10361 |
| Number Of Medicare Beneficiaries With Medical Services | 3706 |
| Total Medical Submitted Charge Amount | 1607296 |
| Total Medical Medicare Allowed Amount | 303262.16 |
| Total Medical Medicare Payment Amount | 258868.83 |
| Total Medical Medicare Standardized Payment Amount | 278194.45 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 223 |
| Number Of Beneficiaries Age 65 to 74 | 1699 |
| Number Of Beneficiaries Age 75 to 84 | 1226 |
| Number Of Beneficiaries Age Greater 84 | 558 |
| Number Of Female Beneficiaries | 2921 |
| Number Of Male Beneficiaries | 785 |
| Number Of Non Hispanic White Beneficiaries | 3610 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 42 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3302 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 404 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8332 |