| National Provider Identifier [NPI]: | 1609886449 |
| Last Name Of The Provider | CITRONE |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 HOSPITAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | KETCHUM |
| Zip Code Of The Provider | 83340 |
| 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 | 159 |
| Number Of Services | 2567 |
| Number Of Medicare Beneficiaries | 1797 |
| Total Submitted Charge Amount | 414379.9 |
| Total Medicare Allowed Amount | 91305.03 |
| Total Medicare Payment Amount | 67836.16 |
| Total Medicare Standardized Payment Amount | 72321.61 |
| 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 | 159 |
| Number Of Medical Services | 2567 |
| Number Of Medicare Beneficiaries With Medical Services | 1797 |
| Total Medical Submitted Charge Amount | 414379.9 |
| Total Medical Medicare Allowed Amount | 91305.03 |
| Total Medical Medicare Payment Amount | 67836.16 |
| Total Medical Medicare Standardized Payment Amount | 72321.61 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 288 |
| Number Of Beneficiaries Age 65 to 74 | 756 |
| Number Of Beneficiaries Age 75 to 84 | 491 |
| Number Of Beneficiaries Age Greater 84 | 262 |
| Number Of Female Beneficiaries | 1116 |
| Number Of Male Beneficiaries | 681 |
| Number Of Non Hispanic White Beneficiaries | 1668 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 22 |
| Number Of Hispanic Beneficiaries | 68 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1448 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 349 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4664 |