| National Provider Identifier [NPI]: | 1114121217 |
| Last Name Of The Provider | HANSEN |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1495 E RIDGELINE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTH OGDEN |
| Zip Code Of The Provider | 844054976 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 7130 |
| Number Of Medicare Beneficiaries | 953 |
| Total Submitted Charge Amount | 621964.5 |
| Total Medicare Allowed Amount | 428248.36 |
| Total Medicare Payment Amount | 308668.89 |
| Total Medicare Standardized Payment Amount | 319546.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 64 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 7945 |
| Total Drug Medicare AllowedAmount | 6395.02 |
| Total Drug Medicare PaymentAmount | 4990.81 |
| Total Drug Medicare Standardized Payment Amount | 4990.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 77 |
| Number Of Medical Services | 7066 |
| Number Of Medicare Beneficiaries With Medical Services | 953 |
| Total Medical Submitted Charge Amount | 614019.5 |
| Total Medical Medicare Allowed Amount | 421853.34 |
| Total Medical Medicare Payment Amount | 303678.08 |
| Total Medical Medicare Standardized Payment Amount | 314555.52 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 381 |
| Number Of Beneficiaries Age 75 to 84 | 392 |
| Number Of Beneficiaries Age Greater 84 | 151 |
| Number Of Female Beneficiaries | 459 |
| Number Of Male Beneficiaries | 494 |
| Number Of Non Hispanic White Beneficiaries | 923 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 934 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9203 |