| National Provider Identifier [NPI]: | 1710937156 |
| Last Name Of The Provider | BANTA |
| First Name Of The Provider | BRADY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2600 WILSON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MILES CITY |
| Zip Code Of The Provider | 593015094 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 150 |
| Number Of Services | 4127 |
| Number Of Medicare Beneficiaries | 1473 |
| Total Submitted Charge Amount | 407009.5 |
| Total Medicare Allowed Amount | 115780.88 |
| Total Medicare Payment Amount | 89776.19 |
| Total Medicare Standardized Payment Amount | 90373.67 |
| 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 | 150 |
| Number Of Medical Services | 4127 |
| Number Of Medicare Beneficiaries With Medical Services | 1473 |
| Total Medical Submitted Charge Amount | 407009.5 |
| Total Medical Medicare Allowed Amount | 115780.88 |
| Total Medical Medicare Payment Amount | 89776.19 |
| Total Medical Medicare Standardized Payment Amount | 90373.67 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 146 |
| Number Of Beneficiaries Age 65 to 74 | 593 |
| Number Of Beneficiaries Age 75 to 84 | 448 |
| Number Of Beneficiaries Age Greater 84 | 286 |
| Number Of Female Beneficiaries | 886 |
| Number Of Male Beneficiaries | 587 |
| Number Of Non Hispanic White Beneficiaries | 1426 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 16 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1223 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 250 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.99 |