| National Provider Identifier [NPI]: | 1619154135 |
| Last Name Of The Provider | LUPASH |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4403 HARRISON BLVD |
| Street Address 2 Of The Provider | STE 3650 |
| City Of The Provider | OGDEN |
| Zip Code Of The Provider | 844033271 |
| 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 | 38 |
| Number Of Services | 19022 |
| Number Of Medicare Beneficiaries | 293 |
| Total Submitted Charge Amount | 1496515 |
| Total Medicare Allowed Amount | 867941.1 |
| Total Medicare Payment Amount | 635935.56 |
| Total Medicare Standardized Payment Amount | 641925.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 19 |
| Number Of Drug Services | 17192 |
| Number Of Medicare Beneficiaries With Drug Services | 130 |
| Total Drug Submitted ChargeAmount | 1300224 |
| Total Drug Medicare AllowedAmount | 748875.33 |
| Total Drug Medicare PaymentAmount | 552213.58 |
| Total Drug Medicare Standardized Payment Amount | 552213.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 1830 |
| Number Of Medicare Beneficiaries With Medical Services | 293 |
| Total Medical Submitted Charge Amount | 196291 |
| Total Medical Medicare Allowed Amount | 119065.77 |
| Total Medical Medicare Payment Amount | 83721.98 |
| Total Medical Medicare Standardized Payment Amount | 89712.07 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 132 |
| Number Of Beneficiaries Age 75 to 84 | 85 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 193 |
| Number Of Male Beneficiaries | 100 |
| Number Of Non Hispanic White Beneficiaries | 255 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 255 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 38 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 34 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1915 |