| National Provider Identifier [NPI]: | 1295993871 |
| Last Name Of The Provider | ABBOTT |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 E 3900 S |
| Street Address 2 Of The Provider | ATTN: RADIOLOGY DEPARTMENT |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841241300 |
| 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 | 250 |
| Number Of Services | 2507 |
| Number Of Medicare Beneficiaries | 1196 |
| Total Submitted Charge Amount | 609615.93 |
| Total Medicare Allowed Amount | 190260.7 |
| Total Medicare Payment Amount | 145330.21 |
| Total Medicare Standardized Payment Amount | 149761.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 443 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 1510.15 |
| Total Drug Medicare AllowedAmount | 197.55 |
| Total Drug Medicare PaymentAmount | 154.87 |
| Total Drug Medicare Standardized Payment Amount | 154.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 244 |
| Number Of Medical Services | 2064 |
| Number Of Medicare Beneficiaries With Medical Services | 1196 |
| Total Medical Submitted Charge Amount | 608105.78 |
| Total Medical Medicare Allowed Amount | 190063.15 |
| Total Medical Medicare Payment Amount | 145175.34 |
| Total Medical Medicare Standardized Payment Amount | 149606.34 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 138 |
| Number Of Beneficiaries Age 65 to 74 | 414 |
| Number Of Beneficiaries Age 75 to 84 | 422 |
| Number Of Beneficiaries Age Greater 84 | 222 |
| Number Of Female Beneficiaries | 679 |
| Number Of Male Beneficiaries | 517 |
| Number Of Non Hispanic White Beneficiaries | 1083 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 61 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1046 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 150 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7655 |