| National Provider Identifier [NPI]: | 1326117706 |
| Last Name Of The Provider | FORREST |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6901 N 72ND ST |
| Street Address 2 Of The Provider | ALEGENT IMMANUEL HOSPITAL DEPT OF RADIOLOGY |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681221709 |
| 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 | 153 |
| Number Of Services | 4427 |
| Number Of Medicare Beneficiaries | 2846 |
| Total Submitted Charge Amount | 525334 |
| Total Medicare Allowed Amount | 141086.28 |
| Total Medicare Payment Amount | 108983.52 |
| Total Medicare Standardized Payment Amount | 116561.09 |
| 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 | 153 |
| Number Of Medical Services | 4427 |
| Number Of Medicare Beneficiaries With Medical Services | 2846 |
| Total Medical Submitted Charge Amount | 525334 |
| Total Medical Medicare Allowed Amount | 141086.28 |
| Total Medical Medicare Payment Amount | 108983.52 |
| Total Medical Medicare Standardized Payment Amount | 116561.09 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 465 |
| Number Of Beneficiaries Age 65 to 74 | 1042 |
| Number Of Beneficiaries Age 75 to 84 | 786 |
| Number Of Beneficiaries Age Greater 84 | 553 |
| Number Of Female Beneficiaries | 1864 |
| Number Of Male Beneficiaries | 982 |
| Number Of Non Hispanic White Beneficiaries | 2502 |
| Number Of Black or African American Beneficiaries | 272 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2149 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 697 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.542 |