| National Provider Identifier [NPI]: | 1548451362 |
| Last Name Of The Provider | NACKOS |
| First Name Of The Provider | JEFFREY |
| 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 | 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 | 165 |
| Number Of Services | 20953 |
| Number Of Medicare Beneficiaries | 3657 |
| Total Submitted Charge Amount | 1155121.76 |
| Total Medicare Allowed Amount | 335561.09 |
| Total Medicare Payment Amount | 251073.09 |
| Total Medicare Standardized Payment Amount | 252122.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 15929 |
| Number Of Medicare Beneficiaries With Drug Services | 192 |
| Total Drug Submitted ChargeAmount | 12168.48 |
| Total Drug Medicare AllowedAmount | 5253.52 |
| Total Drug Medicare PaymentAmount | 4099.24 |
| Total Drug Medicare Standardized Payment Amount | 4099.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 161 |
| Number Of Medical Services | 5024 |
| Number Of Medicare Beneficiaries With Medical Services | 3657 |
| Total Medical Submitted Charge Amount | 1142953.28 |
| Total Medical Medicare Allowed Amount | 330307.57 |
| Total Medical Medicare Payment Amount | 246973.85 |
| Total Medical Medicare Standardized Payment Amount | 248023.15 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 643 |
| Number Of Beneficiaries Age 65 to 74 | 1280 |
| Number Of Beneficiaries Age 75 to 84 | 1097 |
| Number Of Beneficiaries Age Greater 84 | 637 |
| Number Of Female Beneficiaries | 1901 |
| Number Of Male Beneficiaries | 1756 |
| Number Of Non Hispanic White Beneficiaries | 3361 |
| Number Of Black or African American Beneficiaries | 40 |
| Number Of AsianPacific Islander Beneficiaries | 56 |
| Number Of Hispanic Beneficiaries | 94 |
| Number Of American Indian Alaska Native Beneficiaries | 73 |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2804 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 853 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7205 |