| National Provider Identifier [NPI]: | 1740245620 |
| Last Name Of The Provider | STEVENSON |
| First Name Of The Provider | LEO |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 555 E 5300 S #7 |
| Street Address 2 Of The Provider | |
| City Of The Provider | OGDEN |
| Zip Code Of The Provider | 844054509 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Obstetrics/Gynecology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 382 |
| Number Of Medicare Beneficiaries | 59 |
| Total Submitted Charge Amount | 20050 |
| Total Medicare Allowed Amount | 15291.11 |
| Total Medicare Payment Amount | 8131.78 |
| Total Medicare Standardized Payment Amount | 8722.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 244 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 4150 |
| Total Drug Medicare AllowedAmount | 2767.48 |
| Total Drug Medicare PaymentAmount | 2109.05 |
| Total Drug Medicare Standardized Payment Amount | 2109.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 5 |
| Number Of Medical Services | 138 |
| Number Of Medicare Beneficiaries With Medical Services | 59 |
| Total Medical Submitted Charge Amount | 15900 |
| Total Medical Medicare Allowed Amount | 12523.63 |
| Total Medical Medicare Payment Amount | 6022.73 |
| Total Medical Medicare Standardized Payment Amount | 6613.14 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 33 |
| Number Of Beneficiaries Age 75 to 84 | 13 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 0 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.8987 |