| National Provider Identifier [NPI]: | 1225141211 |
| Last Name Of The Provider | BENES |
| First Name Of The Provider | MICHELLE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 16909 LAKESIDE HILLS CT |
| Street Address 2 Of The Provider | SUTIE 300 |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681304664 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 1153 |
| Number Of Medicare Beneficiaries | 211 |
| Total Submitted Charge Amount | 127621.4 |
| Total Medicare Allowed Amount | 61065.6 |
| Total Medicare Payment Amount | 44190.25 |
| Total Medicare Standardized Payment Amount | 48028.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 17 |
| Number Of Drug Services | 186 |
| Number Of Medicare Beneficiaries With Drug Services | 74 |
| Total Drug Submitted ChargeAmount | 9101.4 |
| Total Drug Medicare AllowedAmount | 4658.93 |
| Total Drug Medicare PaymentAmount | 4506.66 |
| Total Drug Medicare Standardized Payment Amount | 4506.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 967 |
| Number Of Medicare Beneficiaries With Medical Services | 211 |
| Total Medical Submitted Charge Amount | 118520 |
| Total Medical Medicare Allowed Amount | 56406.67 |
| Total Medical Medicare Payment Amount | 39683.59 |
| Total Medical Medicare Standardized Payment Amount | 43522.18 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 118 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 160 |
| Number Of Male Beneficiaries | 51 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 196 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 5 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8139 |