| National Provider Identifier [NPI]: | 1659351344 |
| Last Name Of The Provider | STALEY |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13103 E MANSFIELD |
| Street Address 2 Of The Provider | INCYTE PATHOLOGY PS |
| City Of The Provider | SPOKANE |
| Zip Code Of The Provider | 99216 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 2782 |
| Number Of Medicare Beneficiaries | 1012 |
| Total Submitted Charge Amount | 199505 |
| Total Medicare Allowed Amount | 95127.05 |
| Total Medicare Payment Amount | 72509.86 |
| Total Medicare Standardized Payment Amount | 58745.22 |
| 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 | 28 |
| Number Of Medical Services | 2782 |
| Number Of Medicare Beneficiaries With Medical Services | 1012 |
| Total Medical Submitted Charge Amount | 199505 |
| Total Medical Medicare Allowed Amount | 95127.05 |
| Total Medical Medicare Payment Amount | 72509.86 |
| Total Medical Medicare Standardized Payment Amount | 58745.22 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 148 |
| Number Of Beneficiaries Age 65 to 74 | 459 |
| Number Of Beneficiaries Age 75 to 84 | 295 |
| Number Of Beneficiaries Age Greater 84 | 110 |
| Number Of Female Beneficiaries | 519 |
| Number Of Male Beneficiaries | 493 |
| Number Of Non Hispanic White Beneficiaries | 904 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 74 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 823 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 189 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3537 |