| National Provider Identifier [NPI]: | 1366482432 |
| Last Name Of The Provider | STEPHENSON |
| First Name Of The Provider | BRENT |
| 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 | 5444 GREEN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MURRAY |
| Zip Code Of The Provider | 841235632 |
| 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 | 120 |
| Number Of Services | 2138 |
| Number Of Medicare Beneficiaries | 1596 |
| Total Submitted Charge Amount | 227815.95 |
| Total Medicare Allowed Amount | 65210.3 |
| Total Medicare Payment Amount | 49624.95 |
| Total Medicare Standardized Payment Amount | 51487.85 |
| 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 | 120 |
| Number Of Medical Services | 2138 |
| Number Of Medicare Beneficiaries With Medical Services | 1596 |
| Total Medical Submitted Charge Amount | 227815.95 |
| Total Medical Medicare Allowed Amount | 65210.3 |
| Total Medical Medicare Payment Amount | 49624.95 |
| Total Medical Medicare Standardized Payment Amount | 51487.85 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 345 |
| Number Of Beneficiaries Age 65 to 74 | 572 |
| Number Of Beneficiaries Age 75 to 84 | 453 |
| Number Of Beneficiaries Age Greater 84 | 226 |
| Number Of Female Beneficiaries | 955 |
| Number Of Male Beneficiaries | 641 |
| Number Of Non Hispanic White Beneficiaries | 1393 |
| Number Of Black or African American Beneficiaries | 26 |
| Number Of AsianPacific Islander Beneficiaries | 44 |
| Number Of Hispanic Beneficiaries | 102 |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1266 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 330 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5636 |