| National Provider Identifier [NPI]: | 1063477834 |
| Last Name Of The Provider | KOTULA |
| First Name Of The Provider | RUDOLF |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10060 REGENCY CIR |
| Street Address 2 Of The Provider | |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681143732 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 7002 |
| Number Of Medicare Beneficiaries | 416 |
| Total Submitted Charge Amount | 535735.84 |
| Total Medicare Allowed Amount | 231514.77 |
| Total Medicare Payment Amount | 180477.04 |
| Total Medicare Standardized Payment Amount | 191638.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 4072 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 13870 |
| Total Drug Medicare AllowedAmount | 3976.68 |
| Total Drug Medicare PaymentAmount | 3152.78 |
| Total Drug Medicare Standardized Payment Amount | 3152.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 2930 |
| Number Of Medicare Beneficiaries With Medical Services | 416 |
| Total Medical Submitted Charge Amount | 521865.84 |
| Total Medical Medicare Allowed Amount | 227538.09 |
| Total Medical Medicare Payment Amount | 177324.26 |
| Total Medical Medicare Standardized Payment Amount | 188485.89 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 70 |
| Number Of Beneficiaries Age 65 to 74 | 147 |
| Number Of Beneficiaries Age 75 to 84 | 137 |
| Number Of Beneficiaries Age Greater 84 | 62 |
| Number Of Female Beneficiaries | 227 |
| Number Of Male Beneficiaries | 189 |
| Number Of Non Hispanic White Beneficiaries | 377 |
| Number Of Black or African American Beneficiaries | 19 |
| 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 | 309 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 107 |
| Percent Of With Atrial Fibrillation | 32 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 59 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.4287 |