| National Provider Identifier [NPI]: | 1144264045 |
| Last Name Of The Provider | DAINES |
| First Name Of The Provider | CLARK |
| Middle Initial Of The Provider | R |
| 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 | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 4649 |
| Number Of Medicare Beneficiaries | 1876 |
| Total Submitted Charge Amount | 598451.5 |
| Total Medicare Allowed Amount | 235154.46 |
| Total Medicare Payment Amount | 179318.71 |
| Total Medicare Standardized Payment Amount | 133364.23 |
| 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 | 26 |
| Number Of Medical Services | 4649 |
| Number Of Medicare Beneficiaries With Medical Services | 1876 |
| Total Medical Submitted Charge Amount | 598451.5 |
| Total Medical Medicare Allowed Amount | 235154.46 |
| Total Medical Medicare Payment Amount | 179318.71 |
| Total Medical Medicare Standardized Payment Amount | 133364.23 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 258 |
| Number Of Beneficiaries Age 65 to 74 | 810 |
| Number Of Beneficiaries Age 75 to 84 | 573 |
| Number Of Beneficiaries Age Greater 84 | 235 |
| Number Of Female Beneficiaries | 959 |
| Number Of Male Beneficiaries | 917 |
| Number Of Non Hispanic White Beneficiaries | 1795 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 42 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1555 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 321 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.108 |