| National Provider Identifier [NPI]: | 1386673135 |
| Last Name Of The Provider | KIMBALL |
| First Name Of The Provider | JORDAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 389 S 900 E |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841022310 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 147 |
| Number Of Services | 9216 |
| Number Of Medicare Beneficiaries | 2308 |
| Total Submitted Charge Amount | 475857 |
| Total Medicare Allowed Amount | 145550.52 |
| Total Medicare Payment Amount | 112772.73 |
| Total Medicare Standardized Payment Amount | 121682.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 6178 |
| Number Of Medicare Beneficiaries With Drug Services | 118 |
| Total Drug Submitted ChargeAmount | 10960 |
| Total Drug Medicare AllowedAmount | 2867.39 |
| Total Drug Medicare PaymentAmount | 2206.94 |
| Total Drug Medicare Standardized Payment Amount | 2206.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 144 |
| Number Of Medical Services | 3038 |
| Number Of Medicare Beneficiaries With Medical Services | 2306 |
| Total Medical Submitted Charge Amount | 464897 |
| Total Medical Medicare Allowed Amount | 142683.13 |
| Total Medical Medicare Payment Amount | 110565.79 |
| Total Medical Medicare Standardized Payment Amount | 119476.05 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 280 |
| Number Of Beneficiaries Age 65 to 74 | 890 |
| Number Of Beneficiaries Age 75 to 84 | 773 |
| Number Of Beneficiaries Age Greater 84 | 365 |
| Number Of Female Beneficiaries | 1514 |
| Number Of Male Beneficiaries | 794 |
| Number Of Non Hispanic White Beneficiaries | 2116 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 40 |
| Number Of Hispanic Beneficiaries | 98 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2020 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 288 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0893 |