| National Provider Identifier [NPI]: | 1023394665 |
| Last Name Of The Provider | PARK |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 515 N 162ND AVE |
| Street Address 2 Of The Provider | STE. 300 |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681182539 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Vascular Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 130 |
| Number Of Services | 1902 |
| Number Of Medicare Beneficiaries | 972 |
| Total Submitted Charge Amount | 1471166.65 |
| Total Medicare Allowed Amount | 226661.8 |
| Total Medicare Payment Amount | 173267.09 |
| Total Medicare Standardized Payment Amount | 191660.95 |
| 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 | 130 |
| Number Of Medical Services | 1902 |
| Number Of Medicare Beneficiaries With Medical Services | 972 |
| Total Medical Submitted Charge Amount | 1471166.65 |
| Total Medical Medicare Allowed Amount | 226661.8 |
| Total Medical Medicare Payment Amount | 173267.09 |
| Total Medical Medicare Standardized Payment Amount | 191660.95 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 109 |
| Number Of Beneficiaries Age 65 to 74 | 375 |
| Number Of Beneficiaries Age 75 to 84 | 331 |
| Number Of Beneficiaries Age Greater 84 | 157 |
| Number Of Female Beneficiaries | 559 |
| Number Of Male Beneficiaries | 413 |
| Number Of Non Hispanic White Beneficiaries | 908 |
| Number Of Black or African American Beneficiaries | 27 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 807 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 165 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7804 |