| National Provider Identifier [NPI]: | 1407819824 |
| Last Name Of The Provider | TEEL |
| First Name Of The Provider | GORDON |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 801 S STEVENS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPOKANE |
| Zip Code Of The Provider | 992042654 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 155 |
| Number Of Services | 34137 |
| Number Of Medicare Beneficiaries | 3395 |
| Total Submitted Charge Amount | 1436467.5 |
| Total Medicare Allowed Amount | 368276.89 |
| Total Medicare Payment Amount | 279428.39 |
| Total Medicare Standardized Payment Amount | 281927.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 29250 |
| Number Of Medicare Beneficiaries With Drug Services | 258 |
| Total Drug Submitted ChargeAmount | 16677.36 |
| Total Drug Medicare AllowedAmount | 5934.91 |
| Total Drug Medicare PaymentAmount | 4614.92 |
| Total Drug Medicare Standardized Payment Amount | 4614.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 151 |
| Number Of Medical Services | 4887 |
| Number Of Medicare Beneficiaries With Medical Services | 3395 |
| Total Medical Submitted Charge Amount | 1419790.14 |
| Total Medical Medicare Allowed Amount | 362341.98 |
| Total Medical Medicare Payment Amount | 274813.47 |
| Total Medical Medicare Standardized Payment Amount | 277313.04 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 549 |
| Number Of Beneficiaries Age 65 to 74 | 1248 |
| Number Of Beneficiaries Age 75 to 84 | 1061 |
| Number Of Beneficiaries Age Greater 84 | 537 |
| Number Of Female Beneficiaries | 1793 |
| Number Of Male Beneficiaries | 1602 |
| Number Of Non Hispanic White Beneficiaries | 3114 |
| Number Of Black or African American Beneficiaries | 44 |
| Number Of AsianPacific Islander Beneficiaries | 53 |
| Number Of Hispanic Beneficiaries | 80 |
| Number Of American Indian Alaska Native Beneficiaries | 65 |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2656 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 739 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.7769 |