| National Provider Identifier [NPI]: | 1558301366 |
| Last Name Of The Provider | GORDON |
| First Name Of The Provider | DENNIS |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3336 PIONEER PKWY |
| Street Address 2 Of The Provider | SUITE 203 |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841202000 |
| 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 | 59 |
| Number Of Services | 650 |
| Number Of Medicare Beneficiaries | 90 |
| Total Submitted Charge Amount | 124857.09 |
| Total Medicare Allowed Amount | 48648.67 |
| Total Medicare Payment Amount | 35998.51 |
| Total Medicare Standardized Payment Amount | 36930.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 185 |
| Number Of Medicare Beneficiaries With Drug Services | 36 |
| Total Drug Submitted ChargeAmount | 6713 |
| Total Drug Medicare AllowedAmount | 3106.35 |
| Total Drug Medicare PaymentAmount | 2424.29 |
| Total Drug Medicare Standardized Payment Amount | 2424.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 465 |
| Number Of Medicare Beneficiaries With Medical Services | 90 |
| Total Medical Submitted Charge Amount | 118144.09 |
| Total Medical Medicare Allowed Amount | 45542.32 |
| Total Medical Medicare Payment Amount | 33574.22 |
| Total Medical Medicare Standardized Payment Amount | 34505.74 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 37 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 64 |
| Number Of Male Beneficiaries | 26 |
| Number Of Non Hispanic White Beneficiaries | 79 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 75 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 74 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1293 |