| National Provider Identifier [NPI]: | 1336129451 |
| Last Name Of The Provider | HICKS |
| First Name Of The Provider | STANLEY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 LINCOLN ST |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | KELSO |
| Zip Code Of The Provider | 986261057 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 156 |
| Number Of Services | 9449 |
| Number Of Medicare Beneficiaries | 2810 |
| Total Submitted Charge Amount | 554960.4 |
| Total Medicare Allowed Amount | 157222.04 |
| Total Medicare Payment Amount | 121223.71 |
| Total Medicare Standardized Payment Amount | 123727.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 4289 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 3402.4 |
| Total Drug Medicare AllowedAmount | 899.18 |
| Total Drug Medicare PaymentAmount | 696.93 |
| Total Drug Medicare Standardized Payment Amount | 696.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 152 |
| Number Of Medical Services | 5160 |
| Number Of Medicare Beneficiaries With Medical Services | 2810 |
| Total Medical Submitted Charge Amount | 551558 |
| Total Medical Medicare Allowed Amount | 156322.86 |
| Total Medical Medicare Payment Amount | 120526.78 |
| Total Medical Medicare Standardized Payment Amount | 123030.69 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 600 |
| Number Of Beneficiaries Age 65 to 74 | 1123 |
| Number Of Beneficiaries Age 75 to 84 | 710 |
| Number Of Beneficiaries Age Greater 84 | 377 |
| Number Of Female Beneficiaries | 1906 |
| Number Of Male Beneficiaries | 904 |
| Number Of Non Hispanic White Beneficiaries | 2671 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | 38 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2015 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 795 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3804 |