| National Provider Identifier [NPI]: | 1164486528 |
| Last Name Of The Provider | DEWALD |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | D |
| 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 | 226 |
| Number Of Services | 13002 |
| Number Of Medicare Beneficiaries | 4594 |
| Total Submitted Charge Amount | 1246520 |
| Total Medicare Allowed Amount | 289677.49 |
| Total Medicare Payment Amount | 224483.45 |
| Total Medicare Standardized Payment Amount | 243336.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 5944 |
| Number Of Medicare Beneficiaries With Drug Services | 96 |
| Total Drug Submitted ChargeAmount | 5030 |
| Total Drug Medicare AllowedAmount | 2283.45 |
| Total Drug Medicare PaymentAmount | 1776.38 |
| Total Drug Medicare Standardized Payment Amount | 1776.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 218 |
| Number Of Medical Services | 7058 |
| Number Of Medicare Beneficiaries With Medical Services | 4594 |
| Total Medical Submitted Charge Amount | 1241490 |
| Total Medical Medicare Allowed Amount | 287394.04 |
| Total Medical Medicare Payment Amount | 222707.07 |
| Total Medical Medicare Standardized Payment Amount | 241559.99 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 568 |
| Number Of Beneficiaries Age 65 to 74 | 1758 |
| Number Of Beneficiaries Age 75 to 84 | 1411 |
| Number Of Beneficiaries Age Greater 84 | 857 |
| Number Of Female Beneficiaries | 2975 |
| Number Of Male Beneficiaries | 1619 |
| Number Of Non Hispanic White Beneficiaries | 4450 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 49 |
| Number Of American Indian Alaska Native Beneficiaries | 15 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3718 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 876 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2852 |