| National Provider Identifier [NPI]: | 1073558268 |
| Last Name Of The Provider | PEDERSEN |
| First Name Of The Provider | ERIK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7500 MERCY RD |
| Street Address 2 Of The Provider | ALEGENT BERGAN MERCY DEPT OF RADIOLOGY |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681242319 |
| 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 | 107 |
| Number Of Services | 3478 |
| Number Of Medicare Beneficiaries | 2606 |
| Total Submitted Charge Amount | 631743 |
| Total Medicare Allowed Amount | 174224.99 |
| Total Medicare Payment Amount | 131407.45 |
| Total Medicare Standardized Payment Amount | 141233.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 107 |
| Number Of Medical Services | 3478 |
| Number Of Medicare Beneficiaries With Medical Services | 2606 |
| Total Medical Submitted Charge Amount | 631743 |
| Total Medical Medicare Allowed Amount | 174224.99 |
| Total Medical Medicare Payment Amount | 131407.45 |
| Total Medical Medicare Standardized Payment Amount | 141233.4 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 404 |
| Number Of Beneficiaries Age 65 to 74 | 940 |
| Number Of Beneficiaries Age 75 to 84 | 795 |
| Number Of Beneficiaries Age Greater 84 | 467 |
| Number Of Female Beneficiaries | 1557 |
| Number Of Male Beneficiaries | 1049 |
| Number Of Non Hispanic White Beneficiaries | 2369 |
| Number Of Black or African American Beneficiaries | 139 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 53 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2060 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 546 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.5022 |