| National Provider Identifier [NPI]: | 1780679829 |
| Last Name Of The Provider | HUMISTON |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2132 NORTH 1700 WEST |
| Street Address 2 Of The Provider | SUITE #200 |
| City Of The Provider | LAYTON |
| Zip Code Of The Provider | 840411130 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 3667 |
| Number Of Medicare Beneficiaries | 1139 |
| Total Submitted Charge Amount | 872340.5 |
| Total Medicare Allowed Amount | 372047.23 |
| Total Medicare Payment Amount | 268297.63 |
| Total Medicare Standardized Payment Amount | 284861.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 272 |
| Number Of Medicare Beneficiaries With Drug Services | 68 |
| Total Drug Submitted ChargeAmount | 19040 |
| Total Drug Medicare AllowedAmount | 14422.52 |
| Total Drug Medicare PaymentAmount | 11000.24 |
| Total Drug Medicare Standardized Payment Amount | 11000.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 3395 |
| Number Of Medicare Beneficiaries With Medical Services | 1139 |
| Total Medical Submitted Charge Amount | 853300.5 |
| Total Medical Medicare Allowed Amount | 357624.71 |
| Total Medical Medicare Payment Amount | 257297.39 |
| Total Medical Medicare Standardized Payment Amount | 273861.03 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 76 |
| Number Of Beneficiaries Age 65 to 74 | 448 |
| Number Of Beneficiaries Age 75 to 84 | 408 |
| Number Of Beneficiaries Age Greater 84 | 207 |
| Number Of Female Beneficiaries | 500 |
| Number Of Male Beneficiaries | 639 |
| Number Of Non Hispanic White Beneficiaries | 1061 |
| Number Of Black or African American Beneficiaries | 17 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1085 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4064 |