| National Provider Identifier [NPI]: | 1770781932 |
| Last Name Of The Provider | BENTLEY |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 50 N MEDICAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841320100 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 210 |
| Number Of Services | 20850 |
| Number Of Medicare Beneficiaries | 3151 |
| Total Submitted Charge Amount | 771096.01 |
| Total Medicare Allowed Amount | 234245.55 |
| Total Medicare Payment Amount | 182443.42 |
| Total Medicare Standardized Payment Amount | 200083.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 16474 |
| Number Of Medicare Beneficiaries With Drug Services | 130 |
| Total Drug Submitted ChargeAmount | 12232 |
| Total Drug Medicare AllowedAmount | 3385.54 |
| Total Drug Medicare PaymentAmount | 2601.18 |
| Total Drug Medicare Standardized Payment Amount | 2601.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 206 |
| Number Of Medical Services | 4376 |
| Number Of Medicare Beneficiaries With Medical Services | 3151 |
| Total Medical Submitted Charge Amount | 758864.01 |
| Total Medical Medicare Allowed Amount | 230860.01 |
| Total Medical Medicare Payment Amount | 179842.24 |
| Total Medical Medicare Standardized Payment Amount | 197482.48 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 528 |
| Number Of Beneficiaries Age 65 to 74 | 1274 |
| Number Of Beneficiaries Age 75 to 84 | 962 |
| Number Of Beneficiaries Age Greater 84 | 387 |
| Number Of Female Beneficiaries | 1961 |
| Number Of Male Beneficiaries | 1190 |
| Number Of Non Hispanic White Beneficiaries | 2957 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 120 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2409 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 742 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2121 |