| National Provider Identifier [NPI]: | 1821054842 |
| Last Name Of The Provider | HOLLINGSWORTH |
| First Name Of The Provider | MARTIN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3556 W 9800 S |
| Street Address 2 Of The Provider | #101 |
| City Of The Provider | SOUTH JORDAN |
| Zip Code Of The Provider | 840953211 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 1212 |
| Number Of Medicare Beneficiaries | 212 |
| Total Submitted Charge Amount | 105396.51 |
| Total Medicare Allowed Amount | 64499.72 |
| Total Medicare Payment Amount | 43255.09 |
| Total Medicare Standardized Payment Amount | 47284.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 173 |
| Number Of Medicare Beneficiaries With Drug Services | 63 |
| Total Drug Submitted ChargeAmount | 4114.01 |
| Total Drug Medicare AllowedAmount | 1844.93 |
| Total Drug Medicare PaymentAmount | 1705.58 |
| Total Drug Medicare Standardized Payment Amount | 1705.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 65 |
| Number Of Medical Services | 1039 |
| Number Of Medicare Beneficiaries With Medical Services | 211 |
| Total Medical Submitted Charge Amount | 101282.5 |
| Total Medical Medicare Allowed Amount | 62654.79 |
| Total Medical Medicare Payment Amount | 41549.51 |
| Total Medical Medicare Standardized Payment Amount | 45579 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 73 |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 129 |
| Number Of Male Beneficiaries | 83 |
| Number Of Non Hispanic White Beneficiaries | 184 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 160 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 25 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0768 |