| National Provider Identifier [NPI]: | 1063675171 |
| Last Name Of The Provider | PARK |
| First Name Of The Provider | BRANDON |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 389 S 900 E |
| Street Address 2 Of The Provider | SALT LAKE CLINIC |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841022310 |
| 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 | 126 |
| Number Of Services | 26516 |
| Number Of Medicare Beneficiaries | 2666 |
| Total Submitted Charge Amount | 520219 |
| Total Medicare Allowed Amount | 180831.75 |
| Total Medicare Payment Amount | 134479.65 |
| Total Medicare Standardized Payment Amount | 144526.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 23118 |
| Number Of Medicare Beneficiaries With Drug Services | 167 |
| Total Drug Submitted ChargeAmount | 24680 |
| Total Drug Medicare AllowedAmount | 4842.06 |
| Total Drug Medicare PaymentAmount | 3775.39 |
| Total Drug Medicare Standardized Payment Amount | 3775.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 122 |
| Number Of Medical Services | 3398 |
| Number Of Medicare Beneficiaries With Medical Services | 2666 |
| Total Medical Submitted Charge Amount | 495539 |
| Total Medical Medicare Allowed Amount | 175989.69 |
| Total Medical Medicare Payment Amount | 130704.26 |
| Total Medical Medicare Standardized Payment Amount | 140750.82 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 368 |
| Number Of Beneficiaries Age 65 to 74 | 971 |
| Number Of Beneficiaries Age 75 to 84 | 871 |
| Number Of Beneficiaries Age Greater 84 | 456 |
| Number Of Female Beneficiaries | 1639 |
| Number Of Male Beneficiaries | 1027 |
| Number Of Non Hispanic White Beneficiaries | 2417 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 53 |
| Number Of Hispanic Beneficiaries | 126 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 41 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2268 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 398 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1308 |