| National Provider Identifier [NPI]: | 1982721106 |
| Last Name Of The Provider | COLES |
| First Name Of The Provider | ANDREW |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1492 W ANTELOPE DR |
| Street Address 2 Of The Provider | SUITE 203 |
| City Of The Provider | LAYTON |
| Zip Code Of The Provider | 840411139 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 2267 |
| Number Of Medicare Beneficiaries | 191 |
| Total Submitted Charge Amount | 392975.52 |
| Total Medicare Allowed Amount | 167926.94 |
| Total Medicare Payment Amount | 115926.28 |
| Total Medicare Standardized Payment Amount | 129911.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 533 |
| Number Of Medicare Beneficiaries With Drug Services | 77 |
| Total Drug Submitted ChargeAmount | 4285.2 |
| Total Drug Medicare AllowedAmount | 2133.55 |
| Total Drug Medicare PaymentAmount | 1631.87 |
| Total Drug Medicare Standardized Payment Amount | 1631.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 1734 |
| Number Of Medicare Beneficiaries With Medical Services | 191 |
| Total Medical Submitted Charge Amount | 388690.32 |
| Total Medical Medicare Allowed Amount | 165793.39 |
| Total Medical Medicare Payment Amount | 114294.41 |
| Total Medical Medicare Standardized Payment Amount | 128279.86 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 71 |
| Number Of Beneficiaries Age 65 to 74 | 63 |
| Number Of Beneficiaries Age 75 to 84 | 42 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 119 |
| Number Of Male Beneficiaries | 72 |
| Number Of Non Hispanic White Beneficiaries | 172 |
| 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 | 157 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 49 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0394 |