| National Provider Identifier [NPI]: | 1770653321 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | STEVEN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3100 CHANNING WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | IDAHO FALLS |
| Zip Code Of The Provider | 834047533 |
| 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 | 206 |
| Number Of Services | 17017 |
| Number Of Medicare Beneficiaries | 2842 |
| Total Submitted Charge Amount | 1087674.51 |
| Total Medicare Allowed Amount | 343357.01 |
| Total Medicare Payment Amount | 271772.65 |
| Total Medicare Standardized Payment Amount | 294453.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 12363 |
| Number Of Medicare Beneficiaries With Drug Services | 164 |
| Total Drug Submitted ChargeAmount | 29011.7 |
| Total Drug Medicare AllowedAmount | 15683.9 |
| Total Drug Medicare PaymentAmount | 12218.61 |
| Total Drug Medicare Standardized Payment Amount | 12218.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 201 |
| Number Of Medical Services | 4654 |
| Number Of Medicare Beneficiaries With Medical Services | 2842 |
| Total Medical Submitted Charge Amount | 1058662.81 |
| Total Medical Medicare Allowed Amount | 327673.11 |
| Total Medical Medicare Payment Amount | 259554.04 |
| Total Medical Medicare Standardized Payment Amount | 282234.92 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 504 |
| Number Of Beneficiaries Age 65 to 74 | 1107 |
| Number Of Beneficiaries Age 75 to 84 | 860 |
| Number Of Beneficiaries Age Greater 84 | 371 |
| Number Of Female Beneficiaries | 1814 |
| Number Of Male Beneficiaries | 1028 |
| Number Of Non Hispanic White Beneficiaries | 2684 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| Number Of Hispanic Beneficiaries | 86 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2156 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 686 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2103 |