| National Provider Identifier [NPI]: | 1700053337 |
| Last Name Of The Provider | GUSTIN |
| First Name Of The Provider | ZACHARY |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 16120 W DODGE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681182049 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 2094 |
| Number Of Medicare Beneficiaries | 145 |
| Total Submitted Charge Amount | 148885.44 |
| Total Medicare Allowed Amount | 125268.8 |
| Total Medicare Payment Amount | 95230.84 |
| Total Medicare Standardized Payment Amount | 82230.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1102 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 20444 |
| Total Drug Medicare AllowedAmount | 18358.86 |
| Total Drug Medicare PaymentAmount | 14393.32 |
| Total Drug Medicare Standardized Payment Amount | 14393.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 992 |
| Number Of Medicare Beneficiaries With Medical Services | 145 |
| Total Medical Submitted Charge Amount | 128441.44 |
| Total Medical Medicare Allowed Amount | 106909.94 |
| Total Medical Medicare Payment Amount | 80837.52 |
| Total Medical Medicare Standardized Payment Amount | 67837.23 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 51 |
| Number Of Beneficiaries Age 75 to 84 | 42 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 94 |
| Number Of Male Beneficiaries | 51 |
| Number Of Non Hispanic White Beneficiaries | 125 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 67 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3428 |