| National Provider Identifier [NPI]: | 1245264399 |
| Last Name Of The Provider | DIXON |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 260 FALLS AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TWIN FALLS |
| Zip Code Of The Provider | 833013370 |
| 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 | 207 |
| Number Of Services | 4808 |
| Number Of Medicare Beneficiaries | 2685 |
| Total Submitted Charge Amount | 416725 |
| Total Medicare Allowed Amount | 145872.82 |
| Total Medicare Payment Amount | 114631.78 |
| Total Medicare Standardized Payment Amount | 122546.4 |
| 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 | 207 |
| Number Of Medical Services | 4808 |
| Number Of Medicare Beneficiaries With Medical Services | 2685 |
| Total Medical Submitted Charge Amount | 416725 |
| Total Medical Medicare Allowed Amount | 145872.82 |
| Total Medical Medicare Payment Amount | 114631.78 |
| Total Medical Medicare Standardized Payment Amount | 122546.4 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 417 |
| Number Of Beneficiaries Age 65 to 74 | 1031 |
| Number Of Beneficiaries Age 75 to 84 | 835 |
| Number Of Beneficiaries Age Greater 84 | 402 |
| Number Of Female Beneficiaries | 1660 |
| Number Of Male Beneficiaries | 1025 |
| Number Of Non Hispanic White Beneficiaries | 2483 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | 138 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2016 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 669 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4367 |