| National Provider Identifier [NPI]: | 1881649572 |
| Last Name Of The Provider | FRY |
| First Name Of The Provider | STEFANIE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 300 E JEFFERSON ST |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | BOISE |
| Zip Code Of The Provider | 837126246 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 3275 |
| Number Of Medicare Beneficiaries | 2055 |
| Total Submitted Charge Amount | 241420 |
| Total Medicare Allowed Amount | 128703.14 |
| Total Medicare Payment Amount | 93687.72 |
| Total Medicare Standardized Payment Amount | 99322.56 |
| 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 | 50 |
| Number Of Medical Services | 3275 |
| Number Of Medicare Beneficiaries With Medical Services | 2055 |
| Total Medical Submitted Charge Amount | 241420 |
| Total Medical Medicare Allowed Amount | 128703.14 |
| Total Medical Medicare Payment Amount | 93687.72 |
| Total Medical Medicare Standardized Payment Amount | 99322.56 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 273 |
| Number Of Beneficiaries Age 65 to 74 | 774 |
| Number Of Beneficiaries Age 75 to 84 | 674 |
| Number Of Beneficiaries Age Greater 84 | 334 |
| Number Of Female Beneficiaries | 1082 |
| Number Of Male Beneficiaries | 973 |
| Number Of Non Hispanic White Beneficiaries | 1919 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| Number Of Hispanic Beneficiaries | 64 |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1711 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 344 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4725 |