| National Provider Identifier [NPI]: | 1376540955 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1400 N 500 E |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOGAN |
| Zip Code Of The Provider | 843412455 |
| 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 | 187 |
| Number Of Services | 3465 |
| Number Of Medicare Beneficiaries | 1907 |
| Total Submitted Charge Amount | 485578 |
| Total Medicare Allowed Amount | 104687.84 |
| Total Medicare Payment Amount | 80539.28 |
| Total Medicare Standardized Payment Amount | 82931.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 187 |
| Number Of Medical Services | 3465 |
| Number Of Medicare Beneficiaries With Medical Services | 1907 |
| Total Medical Submitted Charge Amount | 485578 |
| Total Medical Medicare Allowed Amount | 104687.84 |
| Total Medical Medicare Payment Amount | 80539.28 |
| Total Medical Medicare Standardized Payment Amount | 82931.72 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 277 |
| Number Of Beneficiaries Age 65 to 74 | 755 |
| Number Of Beneficiaries Age 75 to 84 | 577 |
| Number Of Beneficiaries Age Greater 84 | 298 |
| Number Of Female Beneficiaries | 1211 |
| Number Of Male Beneficiaries | 696 |
| Number Of Non Hispanic White Beneficiaries | 1821 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 49 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1617 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 290 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.148 |