| National Provider Identifier [NPI]: | 1932161775 |
| Last Name Of The Provider | SEIBOLD |
| First Name Of The Provider | CAMERON |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 801 S STEVENS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPOKANE |
| Zip Code Of The Provider | 992042654 |
| 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 | 252 |
| Number Of Services | 14253 |
| Number Of Medicare Beneficiaries | 2154 |
| Total Submitted Charge Amount | 1311576.28 |
| Total Medicare Allowed Amount | 312235.53 |
| Total Medicare Payment Amount | 234981.71 |
| Total Medicare Standardized Payment Amount | 237420.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 10850 |
| Number Of Medicare Beneficiaries With Drug Services | 115 |
| Total Drug Submitted ChargeAmount | 6650.28 |
| Total Drug Medicare AllowedAmount | 1945.62 |
| Total Drug Medicare PaymentAmount | 1525.15 |
| Total Drug Medicare Standardized Payment Amount | 1525.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 246 |
| Number Of Medical Services | 3403 |
| Number Of Medicare Beneficiaries With Medical Services | 2154 |
| Total Medical Submitted Charge Amount | 1304926 |
| Total Medical Medicare Allowed Amount | 310289.91 |
| Total Medical Medicare Payment Amount | 233456.56 |
| Total Medical Medicare Standardized Payment Amount | 235894.97 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 360 |
| Number Of Beneficiaries Age 65 to 74 | 779 |
| Number Of Beneficiaries Age 75 to 84 | 705 |
| Number Of Beneficiaries Age Greater 84 | 310 |
| Number Of Female Beneficiaries | 1149 |
| Number Of Male Beneficiaries | 1005 |
| Number Of Non Hispanic White Beneficiaries | 1998 |
| Number Of Black or African American Beneficiaries | 22 |
| Number Of AsianPacific Islander Beneficiaries | 36 |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | 35 |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1707 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 447 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.8122 |