| National Provider Identifier [NPI]: | 1750342655 |
| Last Name Of The Provider | POWELL |
| First Name Of The Provider | SHANE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 210 W 300 N 75-3 |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROOSEVELT |
| Zip Code Of The Provider | 84066 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 1290 |
| Number Of Medicare Beneficiaries | 457 |
| Total Submitted Charge Amount | 304506 |
| Total Medicare Allowed Amount | 168842.07 |
| Total Medicare Payment Amount | 116201.29 |
| Total Medicare Standardized Payment Amount | 124773.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 167 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 6030 |
| Total Drug Medicare AllowedAmount | 4977.75 |
| Total Drug Medicare PaymentAmount | 3866.74 |
| Total Drug Medicare Standardized Payment Amount | 3866.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 1123 |
| Number Of Medicare Beneficiaries With Medical Services | 457 |
| Total Medical Submitted Charge Amount | 298476 |
| Total Medical Medicare Allowed Amount | 163864.32 |
| Total Medical Medicare Payment Amount | 112334.55 |
| Total Medical Medicare Standardized Payment Amount | 120906.93 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 173 |
| Number Of Beneficiaries Age 75 to 84 | 168 |
| Number Of Beneficiaries Age Greater 84 | 69 |
| Number Of Female Beneficiaries | 255 |
| Number Of Male Beneficiaries | 202 |
| Number Of Non Hispanic White Beneficiaries | 417 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 22 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 388 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 40 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0355 |