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 |