| National Provider Identifier [NPI]: | 1154442507 |
| Last Name Of The Provider | WIEBUSCH |
| First Name Of The Provider | LANCE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5500 PINE LAKE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LINCOLN |
| Zip Code Of The Provider | 685163389 |
| 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 | 146 |
| Number Of Services | 8108 |
| Number Of Medicare Beneficiaries | 661 |
| Total Submitted Charge Amount | 1319845.75 |
| Total Medicare Allowed Amount | 306405.83 |
| Total Medicare Payment Amount | 233018.13 |
| Total Medicare Standardized Payment Amount | 247892.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 4891 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 61221.75 |
| Total Drug Medicare AllowedAmount | 32469.45 |
| Total Drug Medicare PaymentAmount | 25297.87 |
| Total Drug Medicare Standardized Payment Amount | 25297.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 138 |
| Number Of Medical Services | 3217 |
| Number Of Medicare Beneficiaries With Medical Services | 661 |
| Total Medical Submitted Charge Amount | 1258624 |
| Total Medical Medicare Allowed Amount | 273936.38 |
| Total Medical Medicare Payment Amount | 207720.26 |
| Total Medical Medicare Standardized Payment Amount | 222594.17 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 93 |
| Number Of Beneficiaries Age 65 to 74 | 262 |
| Number Of Beneficiaries Age 75 to 84 | 198 |
| Number Of Beneficiaries Age Greater 84 | 108 |
| Number Of Female Beneficiaries | 222 |
| Number Of Male Beneficiaries | 439 |
| Number Of Non Hispanic White Beneficiaries | 634 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 534 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 127 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2805 |