| National Provider Identifier [NPI]: | 1669445474 |
| Last Name Of The Provider | SPAIN |
| First Name Of The Provider | FRANCIS |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 623 S MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOSCOW |
| Zip Code Of The Provider | 838432983 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 141 |
| Number Of Services | 7090.5 |
| Number Of Medicare Beneficiaries | 693 |
| Total Submitted Charge Amount | 405531.02 |
| Total Medicare Allowed Amount | 209610.7 |
| Total Medicare Payment Amount | 164131.62 |
| Total Medicare Standardized Payment Amount | 176408.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 269.5 |
| Number Of Medicare Beneficiaries With Drug Services | 178 |
| Total Drug Submitted ChargeAmount | 5247 |
| Total Drug Medicare AllowedAmount | 4531.19 |
| Total Drug Medicare PaymentAmount | 4363.44 |
| Total Drug Medicare Standardized Payment Amount | 4363.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 129 |
| Number Of Medical Services | 6821 |
| Number Of Medicare Beneficiaries With Medical Services | 693 |
| Total Medical Submitted Charge Amount | 400284.02 |
| Total Medical Medicare Allowed Amount | 205079.51 |
| Total Medical Medicare Payment Amount | 159768.18 |
| Total Medical Medicare Standardized Payment Amount | 172044.74 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 56 |
| Number Of Beneficiaries Age 65 to 74 | 295 |
| Number Of Beneficiaries Age 75 to 84 | 210 |
| Number Of Beneficiaries Age Greater 84 | 132 |
| Number Of Female Beneficiaries | 366 |
| Number Of Male Beneficiaries | 327 |
| Number Of Non Hispanic White Beneficiaries | 666 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 608 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 20 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0587 |