| National Provider Identifier [NPI]: | 1558350512 |
| Last Name Of The Provider | SLETHAUG |
| First Name Of The Provider | GAVIN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3501 N SCOTTSDALE RD |
| Street Address 2 Of The Provider | STE 130 |
| City Of The Provider | SCOTTSDALE |
| Zip Code Of The Provider | 852515648 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 280 |
| Number Of Services | 25906 |
| Number Of Medicare Beneficiaries | 2460 |
| Total Submitted Charge Amount | 1372543 |
| Total Medicare Allowed Amount | 291856.9 |
| Total Medicare Payment Amount | 218760.47 |
| Total Medicare Standardized Payment Amount | 226070.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 21526 |
| Number Of Medicare Beneficiaries With Drug Services | 199 |
| Total Drug Submitted ChargeAmount | 43052 |
| Total Drug Medicare AllowedAmount | 3918.47 |
| Total Drug Medicare PaymentAmount | 3071.87 |
| Total Drug Medicare Standardized Payment Amount | 3071.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 278 |
| Number Of Medical Services | 4380 |
| Number Of Medicare Beneficiaries With Medical Services | 2460 |
| Total Medical Submitted Charge Amount | 1329491 |
| Total Medical Medicare Allowed Amount | 287938.43 |
| Total Medical Medicare Payment Amount | 215688.6 |
| Total Medical Medicare Standardized Payment Amount | 222998.42 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 140 |
| Number Of Beneficiaries Age 65 to 74 | 996 |
| Number Of Beneficiaries Age 75 to 84 | 797 |
| Number Of Beneficiaries Age Greater 84 | 527 |
| Number Of Female Beneficiaries | 1290 |
| Number Of Male Beneficiaries | 1170 |
| Number Of Non Hispanic White Beneficiaries | 2289 |
| Number Of Black or African American Beneficiaries | 36 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 56 |
| Number Of American Indian Alaska Native Beneficiaries | 30 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2290 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 170 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6681 |