| National Provider Identifier [NPI]: | 1679510614 |
| Last Name Of The Provider | BROWN |
| First Name Of The Provider | TERRY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 441 S REDWOOD RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841043539 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 433 |
| Number Of Medicare Beneficiaries | 172 |
| Total Submitted Charge Amount | 41520.23 |
| Total Medicare Allowed Amount | 26562.16 |
| Total Medicare Payment Amount | 17496.03 |
| Total Medicare Standardized Payment Amount | 18303.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 70 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 1156.6 |
| Total Drug Medicare AllowedAmount | 75.49 |
| Total Drug Medicare PaymentAmount | 42.23 |
| Total Drug Medicare Standardized Payment Amount | 42.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 363 |
| Number Of Medicare Beneficiaries With Medical Services | 172 |
| Total Medical Submitted Charge Amount | 40363.63 |
| Total Medical Medicare Allowed Amount | 26486.67 |
| Total Medical Medicare Payment Amount | 17453.8 |
| Total Medical Medicare Standardized Payment Amount | 18261.73 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 78 |
| Number Of Beneficiaries Age 75 to 84 | 39 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 113 |
| Number Of Male Beneficiaries | 59 |
| Number Of Non Hispanic White Beneficiaries | 148 |
| 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 | 138 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9101 |