| National Provider Identifier [NPI]: | 1013964295 |
| Last Name Of The Provider | SEABOURN |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1055 N CURTIS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOISE |
| Zip Code Of The Provider | 837061309 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 165 |
| Number Of Services | 11872 |
| Number Of Medicare Beneficiaries | 2392 |
| Total Submitted Charge Amount | 335091.21 |
| Total Medicare Allowed Amount | 148701.71 |
| Total Medicare Payment Amount | 109668.2 |
| Total Medicare Standardized Payment Amount | 118172.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 8625 |
| Number Of Medicare Beneficiaries With Drug Services | 89 |
| Total Drug Submitted ChargeAmount | 2521.11 |
| Total Drug Medicare AllowedAmount | 2491.63 |
| Total Drug Medicare PaymentAmount | 1899.86 |
| Total Drug Medicare Standardized Payment Amount | 1899.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 157 |
| Number Of Medical Services | 3247 |
| Number Of Medicare Beneficiaries With Medical Services | 2391 |
| Total Medical Submitted Charge Amount | 332570.1 |
| Total Medical Medicare Allowed Amount | 146210.08 |
| Total Medical Medicare Payment Amount | 107768.34 |
| Total Medical Medicare Standardized Payment Amount | 116272.94 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 488 |
| Number Of Beneficiaries Age 65 to 74 | 787 |
| Number Of Beneficiaries Age 75 to 84 | 733 |
| Number Of Beneficiaries Age Greater 84 | 384 |
| Number Of Female Beneficiaries | 1343 |
| Number Of Male Beneficiaries | 1049 |
| Number Of Non Hispanic White Beneficiaries | 2171 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | 151 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1647 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 745 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.6108 |