| National Provider Identifier [NPI]: | 1538190004 |
| Last Name Of The Provider | LACKEY |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 755 S PLEASANT AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | DALLASTOWN |
| Zip Code Of The Provider | 173139252 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 322 |
| Number Of Medicare Beneficiaries | 122 |
| Total Submitted Charge Amount | 28122 |
| Total Medicare Allowed Amount | 22835.78 |
| Total Medicare Payment Amount | 14439.4 |
| Total Medicare Standardized Payment Amount | 15527.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 33 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 1212 |
| Total Drug Medicare AllowedAmount | 1027.06 |
| Total Drug Medicare PaymentAmount | 973.19 |
| Total Drug Medicare Standardized Payment Amount | 973.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 289 |
| Number Of Medicare Beneficiaries With Medical Services | 122 |
| Total Medical Submitted Charge Amount | 26910 |
| Total Medical Medicare Allowed Amount | 21808.72 |
| Total Medical Medicare Payment Amount | 13466.21 |
| Total Medical Medicare Standardized Payment Amount | 14554.67 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 50 |
| Number Of Beneficiaries Age 75 to 84 | 42 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 54 |
| Number Of Male Beneficiaries | 68 |
| 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 | 111 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8924 |