| National Provider Identifier [NPI]: | 1215262944 |
| Last Name Of The Provider | MULYANGOTE |
| First Name Of The Provider | OLIVIER |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3195 S MAIN ST |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841153749 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 226.5 |
| Number Of Medicare Beneficiaries | 40 |
| Total Submitted Charge Amount | 16003.5 |
| Total Medicare Allowed Amount | 12345.16 |
| Total Medicare Payment Amount | 8318.48 |
| Total Medicare Standardized Payment Amount | 10420.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 27.5 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 839.5 |
| Total Drug Medicare AllowedAmount | 154.05 |
| Total Drug Medicare PaymentAmount | 129.24 |
| Total Drug Medicare Standardized Payment Amount | 129.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 199 |
| Number Of Medicare Beneficiaries With Medical Services | 40 |
| Total Medical Submitted Charge Amount | 15164 |
| Total Medical Medicare Allowed Amount | 12191.11 |
| Total Medical Medicare Payment Amount | 8189.24 |
| Total Medical Medicare Standardized Payment Amount | 10291.57 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 17 |
| Number Of Male Beneficiaries | 23 |
| Number Of Non Hispanic White Beneficiaries | 27 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 0 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.7535 |