| National Provider Identifier [NPI]: | 1508953555 |
| Last Name Of The Provider | LARSEN |
| First Name Of The Provider | STEVEN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1151 HOSPITAL WAY |
| Street Address 2 Of The Provider | BLDG B |
| City Of The Provider | POCATELLO |
| Zip Code Of The Provider | 832015091 |
| 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 | 209 |
| Number Of Services | 5376 |
| Number Of Medicare Beneficiaries | 2705 |
| Total Submitted Charge Amount | 630297 |
| Total Medicare Allowed Amount | 169369.66 |
| Total Medicare Payment Amount | 131064.28 |
| Total Medicare Standardized Payment Amount | 138904.48 |
| 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 | 209 |
| Number Of Medical Services | 5376 |
| Number Of Medicare Beneficiaries With Medical Services | 2705 |
| Total Medical Submitted Charge Amount | 630297 |
| Total Medical Medicare Allowed Amount | 169369.66 |
| Total Medical Medicare Payment Amount | 131064.28 |
| Total Medical Medicare Standardized Payment Amount | 138904.48 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 563 |
| Number Of Beneficiaries Age 65 to 74 | 1045 |
| Number Of Beneficiaries Age 75 to 84 | 767 |
| Number Of Beneficiaries Age Greater 84 | 330 |
| Number Of Female Beneficiaries | 1677 |
| Number Of Male Beneficiaries | 1028 |
| Number Of Non Hispanic White Beneficiaries | 2440 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 116 |
| Number Of American Indian Alaska Native Beneficiaries | 93 |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1987 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 718 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.315 |