| National Provider Identifier [NPI]: | 1760400238 |
| Last Name Of The Provider | STODDARD |
| First Name Of The Provider | EARL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 147 W CHUBBUCK RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHUBBUCK |
| Zip Code Of The Provider | 832022314 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 109 |
| Number Of Services | 6365 |
| Number Of Medicare Beneficiaries | 1125 |
| Total Submitted Charge Amount | 1274045 |
| Total Medicare Allowed Amount | 562496.24 |
| Total Medicare Payment Amount | 412420.45 |
| Total Medicare Standardized Payment Amount | 434002.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 69 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 10178 |
| Total Drug Medicare AllowedAmount | 9966.96 |
| Total Drug Medicare PaymentAmount | 7794.62 |
| Total Drug Medicare Standardized Payment Amount | 7794.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 105 |
| Number Of Medical Services | 6296 |
| Number Of Medicare Beneficiaries With Medical Services | 1125 |
| Total Medical Submitted Charge Amount | 1263867 |
| Total Medical Medicare Allowed Amount | 552529.28 |
| Total Medical Medicare Payment Amount | 404625.83 |
| Total Medical Medicare Standardized Payment Amount | 426207.86 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 75 |
| Number Of Beneficiaries Age 65 to 74 | 481 |
| Number Of Beneficiaries Age 75 to 84 | 432 |
| Number Of Beneficiaries Age Greater 84 | 137 |
| Number Of Female Beneficiaries | 570 |
| Number Of Male Beneficiaries | 555 |
| Number Of Non Hispanic White Beneficiaries | 1095 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1038 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 87 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9552 |