| National Provider Identifier [NPI]: | 1982621967 |
| Last Name Of The Provider | BURBANK |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 W IRONWOOD DR |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | COEUR D ALENE |
| Zip Code Of The Provider | 838142656 |
| 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 | 258 |
| Number Of Services | 4288 |
| Number Of Medicare Beneficiaries | 2525 |
| Total Submitted Charge Amount | 521217 |
| Total Medicare Allowed Amount | 138703.58 |
| Total Medicare Payment Amount | 107291.41 |
| Total Medicare Standardized Payment Amount | 113839.17 |
| 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 | 258 |
| Number Of Medical Services | 4288 |
| Number Of Medicare Beneficiaries With Medical Services | 2525 |
| Total Medical Submitted Charge Amount | 521217 |
| Total Medical Medicare Allowed Amount | 138703.58 |
| Total Medical Medicare Payment Amount | 107291.41 |
| Total Medical Medicare Standardized Payment Amount | 113839.17 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 454 |
| Number Of Beneficiaries Age 65 to 74 | 1014 |
| Number Of Beneficiaries Age 75 to 84 | 732 |
| Number Of Beneficiaries Age Greater 84 | 325 |
| Number Of Female Beneficiaries | 1592 |
| Number Of Male Beneficiaries | 933 |
| Number Of Non Hispanic White Beneficiaries | 2411 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | 38 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1924 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 601 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4536 |