| National Provider Identifier [NPI]: | 1720017247 |
| Last Name Of The Provider | ALLEN |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 211 E LOGAN ST |
| Street Address 2 Of The Provider | SUITE 203 |
| City Of The Provider | CALDWELL |
| Zip Code Of The Provider | 83605 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 2199 |
| Number Of Medicare Beneficiaries | 433 |
| Total Submitted Charge Amount | 205435.18 |
| Total Medicare Allowed Amount | 113634.48 |
| Total Medicare Payment Amount | 82612.54 |
| Total Medicare Standardized Payment Amount | 88492.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 631 |
| Number Of Medicare Beneficiaries With Drug Services | 64 |
| Total Drug Submitted ChargeAmount | 5448.01 |
| Total Drug Medicare AllowedAmount | 1860.88 |
| Total Drug Medicare PaymentAmount | 1698.03 |
| Total Drug Medicare Standardized Payment Amount | 1698.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 1568 |
| Number Of Medicare Beneficiaries With Medical Services | 433 |
| Total Medical Submitted Charge Amount | 199987.17 |
| Total Medical Medicare Allowed Amount | 111773.6 |
| Total Medical Medicare Payment Amount | 80914.51 |
| Total Medical Medicare Standardized Payment Amount | 86794.67 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 78 |
| Number Of Beneficiaries Age 65 to 74 | 149 |
| Number Of Beneficiaries Age 75 to 84 | 126 |
| Number Of Beneficiaries Age Greater 84 | 80 |
| Number Of Female Beneficiaries | 251 |
| Number Of Male Beneficiaries | 182 |
| Number Of Non Hispanic White Beneficiaries | 385 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 303 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 130 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5445 |