| National Provider Identifier [NPI]: | 1043217268 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | ROGER |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1059 N 100 W |
| Street Address 2 Of The Provider | |
| City Of The Provider | BEAVER |
| Zip Code Of The Provider | 847131690 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 578 |
| Number Of Medicare Beneficiaries | 200 |
| Total Submitted Charge Amount | 81776.75 |
| Total Medicare Allowed Amount | 47708.65 |
| Total Medicare Payment Amount | 37620.65 |
| Total Medicare Standardized Payment Amount | 38831.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 38 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 1716 |
| Total Drug Medicare AllowedAmount | 1302.62 |
| Total Drug Medicare PaymentAmount | 1265.38 |
| Total Drug Medicare Standardized Payment Amount | 1265.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 76 |
| Number Of Medical Services | 540 |
| Number Of Medicare Beneficiaries With Medical Services | 198 |
| Total Medical Submitted Charge Amount | 80060.75 |
| Total Medical Medicare Allowed Amount | 46406.03 |
| Total Medical Medicare Payment Amount | 36355.27 |
| Total Medical Medicare Standardized Payment Amount | 37565.89 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 72 |
| Number Of Beneficiaries Age 75 to 84 | 60 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 113 |
| Number Of Male Beneficiaries | 87 |
| 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 | 169 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.2204 |