| National Provider Identifier [NPI]: | 1376526434 |
| Last Name Of The Provider | LIEBKEMANN |
| First Name Of The Provider | WALTER |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1331 N ELM ST |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | GREENSBORO |
| Zip Code Of The Provider | 274016302 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 150 |
| Number Of Services | 8541 |
| Number Of Medicare Beneficiaries | 2362 |
| Total Submitted Charge Amount | 747174.13 |
| Total Medicare Allowed Amount | 183622.03 |
| Total Medicare Payment Amount | 137200.96 |
| Total Medicare Standardized Payment Amount | 145466.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 5500 |
| Number Of Medicare Beneficiaries With Drug Services | 82 |
| Total Drug Submitted ChargeAmount | 5008.13 |
| Total Drug Medicare AllowedAmount | 2047.23 |
| Total Drug Medicare PaymentAmount | 1550.81 |
| Total Drug Medicare Standardized Payment Amount | 1550.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 146 |
| Number Of Medical Services | 3041 |
| Number Of Medicare Beneficiaries With Medical Services | 2362 |
| Total Medical Submitted Charge Amount | 742166 |
| Total Medical Medicare Allowed Amount | 181574.8 |
| Total Medical Medicare Payment Amount | 135650.15 |
| Total Medical Medicare Standardized Payment Amount | 143915.57 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 594 |
| Number Of Beneficiaries Age 65 to 74 | 823 |
| Number Of Beneficiaries Age 75 to 84 | 591 |
| Number Of Beneficiaries Age Greater 84 | 354 |
| Number Of Female Beneficiaries | 1375 |
| Number Of Male Beneficiaries | 987 |
| Number Of Non Hispanic White Beneficiaries | 1805 |
| Number Of Black or African American Beneficiaries | 493 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1588 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 774 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7876 |