| National Provider Identifier [NPI]: | 1871528018 |
| Last Name Of The Provider | HENRY |
| First Name Of The Provider | DAN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2295 FOOTHILL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SLC |
| Zip Code Of The Provider | 841094000 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 94 |
| Number Of Services | 2585 |
| Number Of Medicare Beneficiaries | 230 |
| Total Submitted Charge Amount | 141122 |
| Total Medicare Allowed Amount | 68865.63 |
| Total Medicare Payment Amount | 49535.83 |
| Total Medicare Standardized Payment Amount | 52760.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 706 |
| Number Of Medicare Beneficiaries With Drug Services | 121 |
| Total Drug Submitted ChargeAmount | 13453 |
| Total Drug Medicare AllowedAmount | 8055.74 |
| Total Drug Medicare PaymentAmount | 5879.62 |
| Total Drug Medicare Standardized Payment Amount | 5879.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 78 |
| Number Of Medical Services | 1879 |
| Number Of Medicare Beneficiaries With Medical Services | 230 |
| Total Medical Submitted Charge Amount | 127669 |
| Total Medical Medicare Allowed Amount | 60809.89 |
| Total Medical Medicare Payment Amount | 43656.21 |
| Total Medical Medicare Standardized Payment Amount | 46880.88 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 139 |
| Number Of Beneficiaries Age 75 to 84 | 54 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 114 |
| Number Of Male Beneficiaries | 116 |
| Number Of Non Hispanic White Beneficiaries | 218 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 12 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 24 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7294 |