| National Provider Identifier [NPI]: | 1467416453 |
| Last Name Of The Provider | GILLESPIE |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7601 PIONEERS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LINCOLN |
| Zip Code Of The Provider | 685064675 |
| 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 | 217 |
| Number Of Services | 13046 |
| Number Of Medicare Beneficiaries | 4216 |
| Total Submitted Charge Amount | 1431455.21 |
| Total Medicare Allowed Amount | 310906.64 |
| Total Medicare Payment Amount | 237945.99 |
| Total Medicare Standardized Payment Amount | 258174.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 6845 |
| Number Of Medicare Beneficiaries With Drug Services | 121 |
| Total Drug Submitted ChargeAmount | 6263.46 |
| Total Drug Medicare AllowedAmount | 2797.47 |
| Total Drug Medicare PaymentAmount | 2167.04 |
| Total Drug Medicare Standardized Payment Amount | 2167.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 211 |
| Number Of Medical Services | 6201 |
| Number Of Medicare Beneficiaries With Medical Services | 4216 |
| Total Medical Submitted Charge Amount | 1425191.75 |
| Total Medical Medicare Allowed Amount | 308109.17 |
| Total Medical Medicare Payment Amount | 235778.95 |
| Total Medical Medicare Standardized Payment Amount | 256007.63 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 545 |
| Number Of Beneficiaries Age 65 to 74 | 1598 |
| Number Of Beneficiaries Age 75 to 84 | 1323 |
| Number Of Beneficiaries Age Greater 84 | 750 |
| Number Of Female Beneficiaries | 2665 |
| Number Of Male Beneficiaries | 1551 |
| Number Of Non Hispanic White Beneficiaries | 4066 |
| Number Of Black or African American Beneficiaries | 39 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 46 |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3419 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 797 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3404 |