| National Provider Identifier [NPI]: | 1184665473 |
| Last Name Of The Provider | PECK |
| First Name Of The Provider | DALLAS |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1055 N CURTIS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOISE |
| Zip Code Of The Provider | 837061309 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 226 |
| Number Of Services | 11369 |
| Number Of Medicare Beneficiaries | 2239 |
| Total Submitted Charge Amount | 441802.37 |
| Total Medicare Allowed Amount | 208433.38 |
| Total Medicare Payment Amount | 152554.48 |
| Total Medicare Standardized Payment Amount | 167475.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 8242 |
| Number Of Medicare Beneficiaries With Drug Services | 179 |
| Total Drug Submitted ChargeAmount | 5165.12 |
| Total Drug Medicare AllowedAmount | 4822.79 |
| Total Drug Medicare PaymentAmount | 3648.66 |
| Total Drug Medicare Standardized Payment Amount | 3648.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 212 |
| Number Of Medical Services | 3127 |
| Number Of Medicare Beneficiaries With Medical Services | 2238 |
| Total Medical Submitted Charge Amount | 436637.25 |
| Total Medical Medicare Allowed Amount | 203610.59 |
| Total Medical Medicare Payment Amount | 148905.82 |
| Total Medical Medicare Standardized Payment Amount | 163827.19 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 505 |
| Number Of Beneficiaries Age 65 to 74 | 764 |
| Number Of Beneficiaries Age 75 to 84 | 627 |
| Number Of Beneficiaries Age Greater 84 | 343 |
| Number Of Female Beneficiaries | 1293 |
| Number Of Male Beneficiaries | 946 |
| Number Of Non Hispanic White Beneficiaries | 2026 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 29 |
| Number Of Hispanic Beneficiaries | 138 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1541 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 698 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5224 |