| National Provider Identifier [NPI]: | 1265428254 |
| Last Name Of The Provider | KIMBALL |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 AINSWORTH DR |
| Street Address 2 Of The Provider | SUITE 115 |
| City Of The Provider | PRESCOTT |
| Zip Code Of The Provider | 863051667 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 212 |
| Number Of Services | 16683 |
| Number Of Medicare Beneficiaries | 3958 |
| Total Submitted Charge Amount | 1362421.57 |
| Total Medicare Allowed Amount | 387241.62 |
| Total Medicare Payment Amount | 299389.19 |
| Total Medicare Standardized Payment Amount | 305287.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 9784 |
| Number Of Medicare Beneficiaries With Drug Services | 138 |
| Total Drug Submitted ChargeAmount | 10832.57 |
| Total Drug Medicare AllowedAmount | 2714.42 |
| Total Drug Medicare PaymentAmount | 2049.12 |
| Total Drug Medicare Standardized Payment Amount | 2049.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 208 |
| Number Of Medical Services | 6899 |
| Number Of Medicare Beneficiaries With Medical Services | 3958 |
| Total Medical Submitted Charge Amount | 1351589 |
| Total Medical Medicare Allowed Amount | 384527.2 |
| Total Medical Medicare Payment Amount | 297340.07 |
| Total Medical Medicare Standardized Payment Amount | 303238.35 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 305 |
| Number Of Beneficiaries Age 65 to 74 | 1767 |
| Number Of Beneficiaries Age 75 to 84 | 1319 |
| Number Of Beneficiaries Age Greater 84 | 567 |
| Number Of Female Beneficiaries | 2475 |
| Number Of Male Beneficiaries | 1483 |
| Number Of Non Hispanic White Beneficiaries | 3721 |
| Number Of Black or African American Beneficiaries | 20 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 135 |
| Number Of American Indian Alaska Native Beneficiaries | 18 |
| Number Of Beneficiaries With Race Not Else where Classified | 44 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3571 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 387 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.2039 |