| National Provider Identifier [NPI]: | 1932121787 |
| Last Name Of The Provider | HANSON |
| First Name Of The Provider | BERKELEY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5444 GREEN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MURRAY |
| Zip Code Of The Provider | 841235632 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 152 |
| Number Of Services | 3356 |
| Number Of Medicare Beneficiaries | 2273 |
| Total Submitted Charge Amount | 407239.59 |
| Total Medicare Allowed Amount | 101079.9 |
| Total Medicare Payment Amount | 76640.06 |
| Total Medicare Standardized Payment Amount | 79966.62 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 437 |
| Number Of Beneficiaries Age 65 to 74 | 912 |
| Number Of Beneficiaries Age 75 to 84 | 645 |
| Number Of Beneficiaries Age Greater 84 | 279 |
| Number Of Female Beneficiaries | 1344 |
| Number Of Male Beneficiaries | 929 |
| Number Of Non Hispanic White Beneficiaries | 2039 |
| Number Of Black or African American Beneficiaries | 20 |
| Number Of AsianPacific Islander Beneficiaries | 55 |
| Number Of Hispanic Beneficiaries | 118 |
| Number Of American Indian Alaska Native Beneficiaries | 17 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1825 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 448 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4897 |