| National Provider Identifier [NPI]: | 1457309692 |
| Last Name Of The Provider | ENTZIAN |
| First Name Of The Provider | DIRK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5444 S. 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 | 239 |
| Number Of Services | 1405 |
| Number Of Medicare Beneficiaries | 835 |
| Total Submitted Charge Amount | 679818.5 |
| Total Medicare Allowed Amount | 100894.7 |
| Total Medicare Payment Amount | 78158.4 |
| Total Medicare Standardized Payment Amount | 79488.13 |
| 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 | 239 |
| Number Of Medical Services | 1405 |
| Number Of Medicare Beneficiaries With Medical Services | 835 |
| Total Medical Submitted Charge Amount | 679818.5 |
| Total Medical Medicare Allowed Amount | 100894.7 |
| Total Medical Medicare Payment Amount | 78158.4 |
| Total Medical Medicare Standardized Payment Amount | 79488.13 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 136 |
| Number Of Beneficiaries Age 65 to 74 | 311 |
| Number Of Beneficiaries Age 75 to 84 | 247 |
| Number Of Beneficiaries Age Greater 84 | 141 |
| Number Of Female Beneficiaries | 474 |
| Number Of Male Beneficiaries | 361 |
| Number Of Non Hispanic White Beneficiaries | 741 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 51 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 711 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 124 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.8835 |