| National Provider Identifier [NPI]: | 1316113228 |
| Last Name Of The Provider | CHRISTIANSON |
| First Name Of The Provider | KIMBALL |
| Middle Initial Of The Provider | L |
| 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 ROAD |
| 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 | 172 |
| Number Of Services | 7429 |
| Number Of Medicare Beneficiaries | 2761 |
| Total Submitted Charge Amount | 336238.29 |
| Total Medicare Allowed Amount | 138379.41 |
| Total Medicare Payment Amount | 103728.5 |
| Total Medicare Standardized Payment Amount | 111362.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 3328 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 1152.45 |
| Total Drug Medicare AllowedAmount | 1128.24 |
| Total Drug Medicare PaymentAmount | 859.15 |
| Total Drug Medicare Standardized Payment Amount | 859.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 165 |
| Number Of Medical Services | 4101 |
| Number Of Medicare Beneficiaries With Medical Services | 2760 |
| Total Medical Submitted Charge Amount | 335085.84 |
| Total Medical Medicare Allowed Amount | 137251.17 |
| Total Medical Medicare Payment Amount | 102869.35 |
| Total Medical Medicare Standardized Payment Amount | 110502.97 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 511 |
| Number Of Beneficiaries Age 65 to 74 | 1044 |
| Number Of Beneficiaries Age 75 to 84 | 825 |
| Number Of Beneficiaries Age Greater 84 | 381 |
| Number Of Female Beneficiaries | 1810 |
| Number Of Male Beneficiaries | 951 |
| Number Of Non Hispanic White Beneficiaries | 2518 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 25 |
| Number Of Hispanic Beneficiaries | 159 |
| Number Of American Indian Alaska Native Beneficiaries | 30 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1966 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 795 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4387 |