| National Provider Identifier [NPI]: | 1225075450 |
| Last Name Of The Provider | SCALES |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| 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 | 200 |
| Number Of Services | 9353 |
| Number Of Medicare Beneficiaries | 2637 |
| Total Submitted Charge Amount | 345721.78 |
| Total Medicare Allowed Amount | 140392.96 |
| Total Medicare Payment Amount | 103223.8 |
| Total Medicare Standardized Payment Amount | 110567.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 5708 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 1493.65 |
| Total Drug Medicare AllowedAmount | 1474.78 |
| Total Drug Medicare PaymentAmount | 1130.45 |
| Total Drug Medicare Standardized Payment Amount | 1130.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 188 |
| Number Of Medical Services | 3645 |
| Number Of Medicare Beneficiaries With Medical Services | 2637 |
| Total Medical Submitted Charge Amount | 344228.13 |
| Total Medical Medicare Allowed Amount | 138918.18 |
| Total Medical Medicare Payment Amount | 102093.35 |
| Total Medical Medicare Standardized Payment Amount | 109436.71 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 574 |
| Number Of Beneficiaries Age 65 to 74 | 886 |
| Number Of Beneficiaries Age 75 to 84 | 768 |
| Number Of Beneficiaries Age Greater 84 | 409 |
| Number Of Female Beneficiaries | 1543 |
| Number Of Male Beneficiaries | 1094 |
| Number Of Non Hispanic White Beneficiaries | 2389 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 167 |
| Number Of American Indian Alaska Native Beneficiaries | 19 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1793 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 844 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5507 |