| National Provider Identifier [NPI]: | 1104877018 |
| Last Name Of The Provider | BOLTE |
| First Name Of The Provider | STEFANIE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10707 PACIFIC ST |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681144762 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 113 |
| Number Of Services | 5353 |
| Number Of Medicare Beneficiaries | 747 |
| Total Submitted Charge Amount | 865689.7 |
| Total Medicare Allowed Amount | 285904.45 |
| Total Medicare Payment Amount | 214029.73 |
| Total Medicare Standardized Payment Amount | 230303.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 2201 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 71451.7 |
| Total Drug Medicare AllowedAmount | 34273.6 |
| Total Drug Medicare PaymentAmount | 26809.92 |
| Total Drug Medicare Standardized Payment Amount | 26809.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 107 |
| Number Of Medical Services | 3152 |
| Number Of Medicare Beneficiaries With Medical Services | 746 |
| Total Medical Submitted Charge Amount | 794238 |
| Total Medical Medicare Allowed Amount | 251630.85 |
| Total Medical Medicare Payment Amount | 187219.81 |
| Total Medical Medicare Standardized Payment Amount | 203493.73 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 110 |
| Number Of Beneficiaries Age 65 to 74 | 255 |
| Number Of Beneficiaries Age 75 to 84 | 256 |
| Number Of Beneficiaries Age Greater 84 | 126 |
| Number Of Female Beneficiaries | 395 |
| Number Of Male Beneficiaries | 352 |
| Number Of Non Hispanic White Beneficiaries | 708 |
| Number Of Black or African American Beneficiaries | 17 |
| 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 | 597 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 150 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.4195 |