| National Provider Identifier [NPI]: | 1538185749 |
| Last Name Of The Provider | MENDOZA |
| First Name Of The Provider | CHRISTOPHER |
| Middle Initial Of The Provider | J |
| 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 | 84102 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 2320 |
| Number Of Medicare Beneficiaries | 178 |
| Total Submitted Charge Amount | 379914.5 |
| Total Medicare Allowed Amount | 153925.61 |
| Total Medicare Payment Amount | 116619.56 |
| Total Medicare Standardized Payment Amount | 112926.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 1000 |
| Number Of Medicare Beneficiaries With Drug Services | 127 |
| Total Drug Submitted ChargeAmount | 29969 |
| Total Drug Medicare AllowedAmount | 14729.68 |
| Total Drug Medicare PaymentAmount | 11437.21 |
| Total Drug Medicare Standardized Payment Amount | 11437.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 1320 |
| Number Of Medicare Beneficiaries With Medical Services | 178 |
| Total Medical Submitted Charge Amount | 349945.5 |
| Total Medical Medicare Allowed Amount | 139195.93 |
| Total Medical Medicare Payment Amount | 105182.35 |
| Total Medical Medicare Standardized Payment Amount | 101489.11 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 68 |
| Number Of Beneficiaries Age 75 to 84 | 64 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 114 |
| Number Of Male Beneficiaries | 64 |
| Number Of Non Hispanic White Beneficiaries | 158 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 139 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1733 |