| National Provider Identifier [NPI]: | 1194781633 |
| Last Name Of The Provider | CHICHESTER |
| First Name Of The Provider | DAN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1140 E 3900 S |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841241228 |
| 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 | 16 |
| Number Of Services | 595 |
| Number Of Medicare Beneficiaries | 350 |
| Total Submitted Charge Amount | 74414 |
| Total Medicare Allowed Amount | 50264.27 |
| Total Medicare Payment Amount | 34486.92 |
| Total Medicare Standardized Payment Amount | 36154.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 595 |
| Number Of Medicare Beneficiaries With Medical Services | 350 |
| Total Medical Submitted Charge Amount | 74414 |
| Total Medical Medicare Allowed Amount | 50264.27 |
| Total Medical Medicare Payment Amount | 34486.92 |
| Total Medical Medicare Standardized Payment Amount | 36154.82 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 207 |
| Number Of Beneficiaries Age 75 to 84 | 89 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 350 |
| Number Of Male Beneficiaries | 0 |
| Number Of Non Hispanic White Beneficiaries | 326 |
| 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 | 338 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 4 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 14 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 41 |
| Percent Of With Ischemic Heart Disease | 9 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6834 |