| National Provider Identifier [NPI]: | 1447207584 |
| Last Name Of The Provider | GRACE |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8613 N 30TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681121852 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 1243 |
| Number Of Medicare Beneficiaries | 253 |
| Total Submitted Charge Amount | 109180.4 |
| Total Medicare Allowed Amount | 52208.92 |
| Total Medicare Payment Amount | 37077.38 |
| Total Medicare Standardized Payment Amount | 40141.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 175 |
| Number Of Medicare Beneficiaries With Drug Services | 84 |
| Total Drug Submitted ChargeAmount | 8303.4 |
| Total Drug Medicare AllowedAmount | 4371.98 |
| Total Drug Medicare PaymentAmount | 4180.35 |
| Total Drug Medicare Standardized Payment Amount | 4180.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 1068 |
| Number Of Medicare Beneficiaries With Medical Services | 253 |
| Total Medical Submitted Charge Amount | 100877 |
| Total Medical Medicare Allowed Amount | 47836.94 |
| Total Medical Medicare Payment Amount | 32897.03 |
| Total Medical Medicare Standardized Payment Amount | 35960.73 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 76 |
| Number Of Beneficiaries Age 65 to 74 | 98 |
| Number Of Beneficiaries Age 75 to 84 | 51 |
| Number Of Beneficiaries Age Greater 84 | 28 |
| Number Of Female Beneficiaries | 146 |
| Number Of Male Beneficiaries | 107 |
| Number Of Non Hispanic White Beneficiaries | 185 |
| Number Of Black or African American Beneficiaries | |
| 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 | 165 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 88 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0903 |