| National Provider Identifier [NPI]: | 1720209018 |
| Last Name Of The Provider | HOM |
| First Name Of The Provider | BENJAMIN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1055 N CURTIS ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOISE |
| Zip Code Of The Provider | 837061309 |
| 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 | 204 |
| Number Of Services | 4989 |
| Number Of Medicare Beneficiaries | 2206 |
| Total Submitted Charge Amount | 331767.71 |
| Total Medicare Allowed Amount | 140848.05 |
| Total Medicare Payment Amount | 103105.83 |
| Total Medicare Standardized Payment Amount | 111596.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 1960 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 715.56 |
| Total Drug Medicare AllowedAmount | 659.35 |
| Total Drug Medicare PaymentAmount | 510.06 |
| Total Drug Medicare Standardized Payment Amount | 510.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 195 |
| Number Of Medical Services | 3029 |
| Number Of Medicare Beneficiaries With Medical Services | 2206 |
| Total Medical Submitted Charge Amount | 331052.15 |
| Total Medical Medicare Allowed Amount | 140188.7 |
| Total Medical Medicare Payment Amount | 102595.77 |
| Total Medical Medicare Standardized Payment Amount | 111086.2 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 520 |
| Number Of Beneficiaries Age 65 to 74 | 777 |
| Number Of Beneficiaries Age 75 to 84 | 571 |
| Number Of Beneficiaries Age Greater 84 | 338 |
| Number Of Female Beneficiaries | 1272 |
| Number Of Male Beneficiaries | 934 |
| Number Of Non Hispanic White Beneficiaries | 2005 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 150 |
| Number Of American Indian Alaska Native Beneficiaries | 18 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1485 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 721 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5188 |