| National Provider Identifier [NPI]: | 1417915430 |
| Last Name Of The Provider | LAMB |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1383 RED CEDAR RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | REXBURG |
| Zip Code Of The Provider | 834405263 |
| 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 | 211 |
| Number Of Services | 7204 |
| Number Of Medicare Beneficiaries | 2724 |
| Total Submitted Charge Amount | 582797 |
| Total Medicare Allowed Amount | 171336.54 |
| Total Medicare Payment Amount | 131602.96 |
| Total Medicare Standardized Payment Amount | 141575.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3052 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 2034 |
| Total Drug Medicare AllowedAmount | 939.14 |
| Total Drug Medicare PaymentAmount | 695.74 |
| Total Drug Medicare Standardized Payment Amount | 695.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 209 |
| Number Of Medical Services | 4152 |
| Number Of Medicare Beneficiaries With Medical Services | 2724 |
| Total Medical Submitted Charge Amount | 580763 |
| Total Medical Medicare Allowed Amount | 170397.4 |
| Total Medical Medicare Payment Amount | 130907.22 |
| Total Medical Medicare Standardized Payment Amount | 140880.09 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 428 |
| Number Of Beneficiaries Age 65 to 74 | 1071 |
| Number Of Beneficiaries Age 75 to 84 | 830 |
| Number Of Beneficiaries Age Greater 84 | 395 |
| Number Of Female Beneficiaries | 1586 |
| Number Of Male Beneficiaries | 1138 |
| Number Of Non Hispanic White Beneficiaries | 2594 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 69 |
| Number Of American Indian Alaska Native Beneficiaries | 18 |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2133 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 591 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.157 |