| National Provider Identifier [NPI]: | 1841372455 |
| Last Name Of The Provider | LACEY |
| First Name Of The Provider | STEFFAN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 109 N 15TH STREET |
| Street Address 2 Of The Provider | SUITE 36 |
| City Of The Provider | NORFOLK |
| Zip Code Of The Provider | 68701 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 4283 |
| Number Of Medicare Beneficiaries | 1431 |
| Total Submitted Charge Amount | 356289.04 |
| Total Medicare Allowed Amount | 155741.95 |
| Total Medicare Payment Amount | 116617.35 |
| Total Medicare Standardized Payment Amount | 83597.72 |
| 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 | 20 |
| Number Of Medical Services | 4283 |
| Number Of Medicare Beneficiaries With Medical Services | 1431 |
| Total Medical Submitted Charge Amount | 356289.04 |
| Total Medical Medicare Allowed Amount | 155741.95 |
| Total Medical Medicare Payment Amount | 116617.35 |
| Total Medical Medicare Standardized Payment Amount | 83597.72 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 123 |
| Number Of Beneficiaries Age 65 to 74 | 638 |
| Number Of Beneficiaries Age 75 to 84 | 477 |
| Number Of Beneficiaries Age Greater 84 | 193 |
| Number Of Female Beneficiaries | 745 |
| Number Of Male Beneficiaries | 686 |
| Number Of Non Hispanic White Beneficiaries | 1391 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1256 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 175 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0508 |