| National Provider Identifier [NPI]: | 1295926061 |
| Last Name Of The Provider | MODICA |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 877 W MAIN ST |
| Street Address 2 Of The Provider | SUITE 603 |
| City Of The Provider | BOISE |
| Zip Code Of The Provider | 837025883 |
| 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 | 191 |
| Number Of Services | 12565 |
| Number Of Medicare Beneficiaries | 2317 |
| Total Submitted Charge Amount | 429158.76 |
| Total Medicare Allowed Amount | 201735.86 |
| Total Medicare Payment Amount | 148890.73 |
| Total Medicare Standardized Payment Amount | 164064.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 9234 |
| Number Of Medicare Beneficiaries With Drug Services | 188 |
| Total Drug Submitted ChargeAmount | 5168.45 |
| Total Drug Medicare AllowedAmount | 4732.56 |
| Total Drug Medicare PaymentAmount | 3576.24 |
| Total Drug Medicare Standardized Payment Amount | 3576.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 181 |
| Number Of Medical Services | 3331 |
| Number Of Medicare Beneficiaries With Medical Services | 2314 |
| Total Medical Submitted Charge Amount | 423990.31 |
| Total Medical Medicare Allowed Amount | 197003.3 |
| Total Medical Medicare Payment Amount | 145314.49 |
| Total Medical Medicare Standardized Payment Amount | 160488.53 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 547 |
| Number Of Beneficiaries Age 65 to 74 | 789 |
| Number Of Beneficiaries Age 75 to 84 | 640 |
| Number Of Beneficiaries Age Greater 84 | 341 |
| Number Of Female Beneficiaries | 1319 |
| Number Of Male Beneficiaries | 998 |
| Number Of Non Hispanic White Beneficiaries | 2082 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 166 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1574 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 743 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5293 |