| National Provider Identifier [NPI]: | 1255354718 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | GORDON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 577 S RIVER RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ST GEORGE |
| Zip Code Of The Provider | 847902097 |
| 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 | 48 |
| Number Of Services | 3337 |
| Number Of Medicare Beneficiaries | 812 |
| Total Submitted Charge Amount | 359846 |
| Total Medicare Allowed Amount | 233114.44 |
| Total Medicare Payment Amount | 172448.71 |
| Total Medicare Standardized Payment Amount | 180161.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 661 |
| Number Of Medicare Beneficiaries With Drug Services | 221 |
| Total Drug Submitted ChargeAmount | 17794 |
| Total Drug Medicare AllowedAmount | 14610.99 |
| Total Drug Medicare PaymentAmount | 13490.47 |
| Total Drug Medicare Standardized Payment Amount | 13490.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 2676 |
| Number Of Medicare Beneficiaries With Medical Services | 812 |
| Total Medical Submitted Charge Amount | 342052 |
| Total Medical Medicare Allowed Amount | 218503.45 |
| Total Medical Medicare Payment Amount | 158958.24 |
| Total Medical Medicare Standardized Payment Amount | 166671.28 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 372 |
| Number Of Beneficiaries Age 75 to 84 | 294 |
| Number Of Beneficiaries Age Greater 84 | 109 |
| Number Of Female Beneficiaries | 457 |
| Number Of Male Beneficiaries | 355 |
| Number Of Non Hispanic White Beneficiaries | 776 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 769 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 43 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0138 |