| National Provider Identifier [NPI]: | 1376665471 |
| Last Name Of The Provider | SHANAHAN |
| First Name Of The Provider | ALEXIS |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 190 E BANNOCK ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOISE |
| Zip Code Of The Provider | 837126241 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 532 |
| Number Of Medicare Beneficiaries | 206 |
| Total Submitted Charge Amount | 83795 |
| Total Medicare Allowed Amount | 49432.4 |
| Total Medicare Payment Amount | 37532.07 |
| Total Medicare Standardized Payment Amount | 39595.56 |
| 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 | 15 |
| Number Of Medical Services | 532 |
| Number Of Medicare Beneficiaries With Medical Services | 206 |
| Total Medical Submitted Charge Amount | 83795 |
| Total Medical Medicare Allowed Amount | 49432.4 |
| Total Medical Medicare Payment Amount | 37532.07 |
| Total Medical Medicare Standardized Payment Amount | 39595.56 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 53 |
| Number Of Beneficiaries Age 75 to 84 | 65 |
| Number Of Beneficiaries Age Greater 84 | 50 |
| Number Of Female Beneficiaries | 118 |
| Number Of Male Beneficiaries | 88 |
| Number Of Non Hispanic White Beneficiaries | 193 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 150 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 56 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 58 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 49 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 23 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.4975 |