| National Provider Identifier [NPI]: | 1255378063 |
| Last Name Of The Provider | SAMUELSON |
| First Name Of The Provider | KENT |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 324 10TH AVENUE |
| Street Address 2 Of The Provider | #100 |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 84103 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 3223 |
| Number Of Medicare Beneficiaries | 218 |
| Total Submitted Charge Amount | 291223 |
| Total Medicare Allowed Amount | 139390.69 |
| Total Medicare Payment Amount | 103506.35 |
| Total Medicare Standardized Payment Amount | 105729.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2271 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 48686 |
| Total Drug Medicare AllowedAmount | 24623.33 |
| Total Drug Medicare PaymentAmount | 19224.98 |
| Total Drug Medicare Standardized Payment Amount | 19224.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 952 |
| Number Of Medicare Beneficiaries With Medical Services | 218 |
| Total Medical Submitted Charge Amount | 242537 |
| Total Medical Medicare Allowed Amount | 114767.36 |
| Total Medical Medicare Payment Amount | 84281.37 |
| Total Medical Medicare Standardized Payment Amount | 86504.39 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 104 |
| Number Of Beneficiaries Age 75 to 84 | 63 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 150 |
| Number Of Male Beneficiaries | 68 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 197 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0512 |