| National Provider Identifier [NPI]: | 1194808394 |
| Last Name Of The Provider | LAKE |
| First Name Of The Provider | DOUGLAS |
| 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 | 1215 DUFF AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | AMES |
| Zip Code Of The Provider | 500103014 |
| 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 | 247 |
| Number Of Services | 6139 |
| Number Of Medicare Beneficiaries | 3562 |
| Total Submitted Charge Amount | 1157725 |
| Total Medicare Allowed Amount | 208509.74 |
| Total Medicare Payment Amount | 164630.34 |
| Total Medicare Standardized Payment Amount | 175943.97 |
| 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 | 247 |
| Number Of Medical Services | 6139 |
| Number Of Medicare Beneficiaries With Medical Services | 3562 |
| Total Medical Submitted Charge Amount | 1157725 |
| Total Medical Medicare Allowed Amount | 208509.74 |
| Total Medical Medicare Payment Amount | 164630.34 |
| Total Medical Medicare Standardized Payment Amount | 175943.97 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 490 |
| Number Of Beneficiaries Age 65 to 74 | 1296 |
| Number Of Beneficiaries Age 75 to 84 | 1155 |
| Number Of Beneficiaries Age Greater 84 | 621 |
| Number Of Female Beneficiaries | 2247 |
| Number Of Male Beneficiaries | 1315 |
| Number Of Non Hispanic White Beneficiaries | 3371 |
| Number Of Black or African American Beneficiaries | 32 |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| Number Of Hispanic Beneficiaries | 79 |
| Number Of American Indian Alaska Native Beneficiaries | 20 |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2830 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 732 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3828 |