| National Provider Identifier [NPI]: | 1184668857 |
| Last Name Of The Provider | KETCHAM |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 E 20TH ST |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | CHEYENNE |
| Zip Code Of The Provider | 820013859 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 293 |
| Number Of Services | 10583 |
| Number Of Medicare Beneficiaries | 4250 |
| Total Submitted Charge Amount | 389791.71 |
| Total Medicare Allowed Amount | 312488.45 |
| Total Medicare Payment Amount | 238795.58 |
| Total Medicare Standardized Payment Amount | 240615.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 2558 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 316.65 |
| Total Drug Medicare AllowedAmount | 315.66 |
| Total Drug Medicare PaymentAmount | 230.87 |
| Total Drug Medicare Standardized Payment Amount | 230.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 290 |
| Number Of Medical Services | 8025 |
| Number Of Medicare Beneficiaries With Medical Services | 4249 |
| Total Medical Submitted Charge Amount | 389475.06 |
| Total Medical Medicare Allowed Amount | 312172.79 |
| Total Medical Medicare Payment Amount | 238564.71 |
| Total Medical Medicare Standardized Payment Amount | 240384.97 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 660 |
| Number Of Beneficiaries Age 65 to 74 | 1527 |
| Number Of Beneficiaries Age 75 to 84 | 1342 |
| Number Of Beneficiaries Age Greater 84 | 721 |
| Number Of Female Beneficiaries | 2631 |
| Number Of Male Beneficiaries | 1619 |
| Number Of Non Hispanic White Beneficiaries | 3782 |
| Number Of Black or African American Beneficiaries | 55 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 338 |
| Number Of American Indian Alaska Native Beneficiaries | 21 |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3262 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 988 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3099 |