| National Provider Identifier [NPI]: | 1144416710 |
| Last Name Of The Provider | LANCE |
| First Name Of The Provider | JASON |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4650 HARRISON N BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | OGDEN |
| Zip Code Of The Provider | 844034303 |
| 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 | 191 |
| Number Of Services | 8364 |
| Number Of Medicare Beneficiaries | 3740 |
| Total Submitted Charge Amount | 715133.55 |
| Total Medicare Allowed Amount | 216738.62 |
| Total Medicare Payment Amount | 164551.09 |
| Total Medicare Standardized Payment Amount | 179096.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2745 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 1965 |
| Total Drug Medicare AllowedAmount | 648.88 |
| Total Drug Medicare PaymentAmount | 471.72 |
| Total Drug Medicare Standardized Payment Amount | 471.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 189 |
| Number Of Medical Services | 5619 |
| Number Of Medicare Beneficiaries With Medical Services | 3740 |
| Total Medical Submitted Charge Amount | 713168.55 |
| Total Medical Medicare Allowed Amount | 216089.74 |
| Total Medical Medicare Payment Amount | 164079.37 |
| Total Medical Medicare Standardized Payment Amount | 178624.89 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 671 |
| Number Of Beneficiaries Age 65 to 74 | 1516 |
| Number Of Beneficiaries Age 75 to 84 | 1070 |
| Number Of Beneficiaries Age Greater 84 | 483 |
| Number Of Female Beneficiaries | 2261 |
| Number Of Male Beneficiaries | 1479 |
| Number Of Non Hispanic White Beneficiaries | 3516 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 29 |
| Number Of Hispanic Beneficiaries | 121 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2841 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 899 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1828 |