| National Provider Identifier [NPI]: | 1619056199 |
| Last Name Of The Provider | VANCE |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | L |
| 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 | 168 |
| Number Of Services | 5837 |
| Number Of Medicare Beneficiaries | 3479 |
| Total Submitted Charge Amount | 646205.15 |
| Total Medicare Allowed Amount | 196908.54 |
| Total Medicare Payment Amount | 146884.18 |
| Total Medicare Standardized Payment Amount | 159122.83 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 672 |
| Number Of Beneficiaries Age 65 to 74 | 1295 |
| Number Of Beneficiaries Age 75 to 84 | 1003 |
| Number Of Beneficiaries Age Greater 84 | 509 |
| Number Of Female Beneficiaries | 1954 |
| Number Of Male Beneficiaries | 1525 |
| Number Of Non Hispanic White Beneficiaries | 3260 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | 25 |
| Number Of Hispanic Beneficiaries | 127 |
| Number Of American Indian Alaska Native Beneficiaries | 23 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2603 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 876 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.275 |