| National Provider Identifier [NPI]: | 1578711057 |
| Last Name Of The Provider | STODDARD |
| First Name Of The Provider | BREONY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9829 S 1300 E |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | SANDY |
| Zip Code Of The Provider | 840944000 |
| 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 | 35 |
| Number Of Services | 351 |
| Number Of Medicare Beneficiaries | 73 |
| Total Submitted Charge Amount | 40634 |
| Total Medicare Allowed Amount | 16278.6 |
| Total Medicare Payment Amount | 11328.93 |
| Total Medicare Standardized Payment Amount | 13736.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 151 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 6546 |
| Total Drug Medicare AllowedAmount | 2211.44 |
| Total Drug Medicare PaymentAmount | 1820.95 |
| Total Drug Medicare Standardized Payment Amount | 1820.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 200 |
| Number Of Medicare Beneficiaries With Medical Services | 73 |
| Total Medical Submitted Charge Amount | 34088 |
| Total Medical Medicare Allowed Amount | 14067.16 |
| Total Medical Medicare Payment Amount | 9507.98 |
| Total Medical Medicare Standardized Payment Amount | 11915.21 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 45 |
| Number Of Beneficiaries Age 75 to 84 | 14 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 48 |
| Number Of Male Beneficiaries | 25 |
| 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 | |
| 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 | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0904 |