| National Provider Identifier [NPI]: | 1326059155 |
| Last Name Of The Provider | HADERLIE |
| First Name Of The Provider | TODD |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1485 S HIGHWAY 40, SUITE A |
| Street Address 2 Of The Provider | |
| City Of The Provider | HEBER CITY |
| Zip Code Of The Provider | 840323522 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Obstetrics/Gynecology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 481 |
| Number Of Medicare Beneficiaries | 99 |
| Total Submitted Charge Amount | 46592 |
| Total Medicare Allowed Amount | 30218.13 |
| Total Medicare Payment Amount | 23457.74 |
| Total Medicare Standardized Payment Amount | 24996.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 37 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 814 |
| Total Drug Medicare AllowedAmount | 611.51 |
| Total Drug Medicare PaymentAmount | 597.22 |
| Total Drug Medicare Standardized Payment Amount | 597.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 444 |
| Number Of Medicare Beneficiaries With Medical Services | 99 |
| Total Medical Submitted Charge Amount | 45778 |
| Total Medical Medicare Allowed Amount | 29606.62 |
| Total Medical Medicare Payment Amount | 22860.52 |
| Total Medical Medicare Standardized Payment Amount | 24399.02 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 37 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 50 |
| Number Of Male Beneficiaries | 49 |
| 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 | 85 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9844 |