| National Provider Identifier [NPI]: | 1205928546 |
| Last Name Of The Provider | LARSEN |
| First Name Of The Provider | MITCHELL |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1055 N 500 W |
| Street Address 2 Of The Provider | SUITE 121 |
| City Of The Provider | PROVO |
| Zip Code Of The Provider | 84064 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hand Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 115 |
| Number Of Services | 3538 |
| Number Of Medicare Beneficiaries | 429 |
| Total Submitted Charge Amount | 671077 |
| Total Medicare Allowed Amount | 264719.07 |
| Total Medicare Payment Amount | 196937.04 |
| Total Medicare Standardized Payment Amount | 208445.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1674 |
| Number Of Medicare Beneficiaries With Drug Services | 174 |
| Total Drug Submitted ChargeAmount | 20243 |
| Total Drug Medicare AllowedAmount | 8821.15 |
| Total Drug Medicare PaymentAmount | 6572.32 |
| Total Drug Medicare Standardized Payment Amount | 6572.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 113 |
| Number Of Medical Services | 1864 |
| Number Of Medicare Beneficiaries With Medical Services | 429 |
| Total Medical Submitted Charge Amount | 650834 |
| Total Medical Medicare Allowed Amount | 255897.92 |
| Total Medical Medicare Payment Amount | 190364.72 |
| Total Medical Medicare Standardized Payment Amount | 201873.45 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 183 |
| Number Of Beneficiaries Age 75 to 84 | 148 |
| Number Of Beneficiaries Age Greater 84 | 56 |
| Number Of Female Beneficiaries | 266 |
| Number Of Male Beneficiaries | 163 |
| Number Of Non Hispanic White Beneficiaries | 410 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 390 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 65 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2138 |