| National Provider Identifier [NPI]: | 1184943144 |
| Last Name Of The Provider | MARSHALL |
| First Name Of The Provider | JORDON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 777 HOSPITAL WAY |
| Street Address 2 Of The Provider | EMERGENCY DEPARTMENT |
| City Of The Provider | POCATELLO |
| Zip Code Of The Provider | 832015175 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 832 |
| Number Of Medicare Beneficiaries | 492 |
| Total Submitted Charge Amount | 434190 |
| Total Medicare Allowed Amount | 83583.78 |
| Total Medicare Payment Amount | 60723.74 |
| Total Medicare Standardized Payment Amount | 64066.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 832 |
| Number Of Medicare Beneficiaries With Medical Services | 492 |
| Total Medical Submitted Charge Amount | 434190 |
| Total Medical Medicare Allowed Amount | 83583.78 |
| Total Medical Medicare Payment Amount | 60723.74 |
| Total Medical Medicare Standardized Payment Amount | 64066.51 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 170 |
| Number Of Beneficiaries Age 65 to 74 | 127 |
| Number Of Beneficiaries Age 75 to 84 | 113 |
| Number Of Beneficiaries Age Greater 84 | 82 |
| Number Of Female Beneficiaries | 254 |
| Number Of Male Beneficiaries | 238 |
| Number Of Non Hispanic White Beneficiaries | 420 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 281 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 211 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 51 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.7241 |