| National Provider Identifier [NPI]: | 1184656407 |
| Last Name Of The Provider | FORSBERG |
| First Name Of The Provider | FARRELL |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 389 S 900 E |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841022310 |
| 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 | 116 |
| Number Of Services | 15172 |
| Number Of Medicare Beneficiaries | 3863 |
| Total Submitted Charge Amount | 484609 |
| Total Medicare Allowed Amount | 197854.99 |
| Total Medicare Payment Amount | 156313.34 |
| Total Medicare Standardized Payment Amount | 167695.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 8861 |
| Number Of Medicare Beneficiaries With Drug Services | 436 |
| Total Drug Submitted ChargeAmount | 24766 |
| Total Drug Medicare AllowedAmount | 2276.16 |
| Total Drug Medicare PaymentAmount | 1750.32 |
| Total Drug Medicare Standardized Payment Amount | 1750.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 112 |
| Number Of Medical Services | 6311 |
| Number Of Medicare Beneficiaries With Medical Services | 3862 |
| Total Medical Submitted Charge Amount | 459843 |
| Total Medical Medicare Allowed Amount | 195578.83 |
| Total Medical Medicare Payment Amount | 154563.02 |
| Total Medical Medicare Standardized Payment Amount | 165945.55 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 452 |
| Number Of Beneficiaries Age 65 to 74 | 1520 |
| Number Of Beneficiaries Age 75 to 84 | 1332 |
| Number Of Beneficiaries Age Greater 84 | 559 |
| Number Of Female Beneficiaries | 2602 |
| Number Of Male Beneficiaries | 1261 |
| Number Of Non Hispanic White Beneficiaries | 3516 |
| Number Of Black or African American Beneficiaries | 27 |
| Number Of AsianPacific Islander Beneficiaries | 72 |
| Number Of Hispanic Beneficiaries | 176 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 61 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3372 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 491 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0437 |