National Provider Identifier [NPI]: |
1629008065 |
Last Name Of The Provider |
RODGERS |
First Name Of The Provider |
BRIAN |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
D. O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
425 MEDICAL DRIVE |
Street Address 2 Of The Provider |
205 |
City Of The Provider |
BOUNTIFUL |
Zip Code Of The Provider |
84010 |
State Code Of The Provider |
UT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
20 |
Number Of Services |
832 |
Number Of Medicare Beneficiaries |
113 |
Total Submitted Charge Amount |
80795.19 |
Total Medicare Allowed Amount |
45299.58 |
Total Medicare Payment Amount |
31637.58 |
Total Medicare Standardized Payment Amount |
33383.98 |
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 |
20 |
Number Of Medical Services |
832 |
Number Of Medicare Beneficiaries With Medical Services |
113 |
Total Medical Submitted Charge Amount |
80795.19 |
Total Medical Medicare Allowed Amount |
45299.58 |
Total Medical Medicare Payment Amount |
31637.58 |
Total Medical Medicare Standardized Payment Amount |
33383.98 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
30 |
Number Of Beneficiaries Age 65 to 74 |
51 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
63 |
Number Of Male Beneficiaries |
50 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
90 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
23 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
12 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
30 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
57 |
Percent Of With Ischemic Heart Disease |
16 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7757 |