| National Provider Identifier [NPI]: | 1073615241 |
| Last Name Of The Provider | MAXWELL |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3741 W 12600 S |
| Street Address 2 Of The Provider | RIVERTON HOSPITAL |
| City Of The Provider | RIVERTON |
| Zip Code Of The Provider | 84065 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 2049 |
| Number Of Medicare Beneficiaries | 154 |
| Total Submitted Charge Amount | 362853 |
| Total Medicare Allowed Amount | 136324.82 |
| Total Medicare Payment Amount | 104509.73 |
| Total Medicare Standardized Payment Amount | 107281.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 748 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 44144 |
| Total Drug Medicare AllowedAmount | 29564.74 |
| Total Drug Medicare PaymentAmount | 23037.6 |
| Total Drug Medicare Standardized Payment Amount | 23037.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 1301 |
| Number Of Medicare Beneficiaries With Medical Services | 154 |
| Total Medical Submitted Charge Amount | 318709 |
| Total Medical Medicare Allowed Amount | 106760.08 |
| Total Medical Medicare Payment Amount | 81472.13 |
| Total Medical Medicare Standardized Payment Amount | 84243.9 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 64 |
| Number Of Beneficiaries Age 75 to 84 | 62 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 88 |
| Number Of Male Beneficiaries | 66 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 74 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9378 |