| National Provider Identifier [NPI]: | 1043277247 |
| Last Name Of The Provider | LACEY |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12368 STRATFORD DR |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | CLIVE |
| Zip Code Of The Provider | 503258162 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 243 |
| Number Of Services | 4548 |
| Number Of Medicare Beneficiaries | 1288 |
| Total Submitted Charge Amount | 388910 |
| Total Medicare Allowed Amount | 153003.74 |
| Total Medicare Payment Amount | 118878.06 |
| Total Medicare Standardized Payment Amount | 126245.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1955 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 977.5 |
| Total Drug Medicare AllowedAmount | 374.39 |
| Total Drug Medicare PaymentAmount | 293.53 |
| Total Drug Medicare Standardized Payment Amount | 293.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 242 |
| Number Of Medical Services | 2593 |
| Number Of Medicare Beneficiaries With Medical Services | 1288 |
| Total Medical Submitted Charge Amount | 387932.5 |
| Total Medical Medicare Allowed Amount | 152629.35 |
| Total Medical Medicare Payment Amount | 118584.53 |
| Total Medical Medicare Standardized Payment Amount | 125952.19 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 222 |
| Number Of Beneficiaries Age 65 to 74 | 445 |
| Number Of Beneficiaries Age 75 to 84 | 378 |
| Number Of Beneficiaries Age Greater 84 | 243 |
| Number Of Female Beneficiaries | 692 |
| Number Of Male Beneficiaries | 596 |
| Number Of Non Hispanic White Beneficiaries | 1220 |
| Number Of Black or African American Beneficiaries | 35 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1011 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 277 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.8988 |