| National Provider Identifier [NPI]: | 1346329919 |
| Last Name Of The Provider | EDLIN |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | P |
| 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 | 196 |
| Number Of Services | 17991 |
| Number Of Medicare Beneficiaries | 2759 |
| Total Submitted Charge Amount | 948709.18 |
| Total Medicare Allowed Amount | 299566.41 |
| Total Medicare Payment Amount | 235421.49 |
| Total Medicare Standardized Payment Amount | 255096.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 13539 |
| Number Of Medicare Beneficiaries With Drug Services | 153 |
| Total Drug Submitted ChargeAmount | 26516.5 |
| Total Drug Medicare AllowedAmount | 13613.71 |
| Total Drug Medicare PaymentAmount | 10605.79 |
| Total Drug Medicare Standardized Payment Amount | 10605.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 193 |
| Number Of Medical Services | 4452 |
| Number Of Medicare Beneficiaries With Medical Services | 2759 |
| Total Medical Submitted Charge Amount | 922192.68 |
| Total Medical Medicare Allowed Amount | 285952.7 |
| Total Medical Medicare Payment Amount | 224815.7 |
| Total Medical Medicare Standardized Payment Amount | 244490.68 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 438 |
| Number Of Beneficiaries Age 65 to 74 | 1111 |
| Number Of Beneficiaries Age 75 to 84 | 852 |
| Number Of Beneficiaries Age Greater 84 | 358 |
| Number Of Female Beneficiaries | 1695 |
| Number Of Male Beneficiaries | 1064 |
| Number Of Non Hispanic White Beneficiaries | 2644 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 63 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2183 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 576 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.254 |