| National Provider Identifier [NPI]: | 1205864204 |
| Last Name Of The Provider | BROCKENBROUGH |
| First Name Of The Provider | KIMBERLY |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 19020 33RD AVE W |
| Street Address 2 Of The Provider | SUITE 210 |
| City Of The Provider | LYNNWOOD |
| Zip Code Of The Provider | 980364746 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 100 |
| Number Of Services | 1559 |
| Number Of Medicare Beneficiaries | 1073 |
| Total Submitted Charge Amount | 401884.28 |
| Total Medicare Allowed Amount | 48537.4 |
| Total Medicare Payment Amount | 36773.11 |
| Total Medicare Standardized Payment Amount | 37786.72 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 146 |
| Number Of Beneficiaries Age 65 to 74 | 424 |
| Number Of Beneficiaries Age 75 to 84 | 314 |
| Number Of Beneficiaries Age Greater 84 | 189 |
| Number Of Female Beneficiaries | 683 |
| Number Of Male Beneficiaries | 390 |
| Number Of Non Hispanic White Beneficiaries | 930 |
| Number Of Black or African American Beneficiaries | 61 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 848 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 225 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.3491 |