| National Provider Identifier [NPI]: | 1609901610 |
| Last Name Of The Provider | EBERT |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5444 S. 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 | 118 |
| Number Of Services | 3442 |
| Number Of Medicare Beneficiaries | 2351 |
| Total Submitted Charge Amount | 259760.98 |
| Total Medicare Allowed Amount | 79244.63 |
| Total Medicare Payment Amount | 59648.78 |
| Total Medicare Standardized Payment Amount | 62413.85 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
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| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 503 |
| Number Of Beneficiaries Age 65 to 74 | 836 |
| Number Of Beneficiaries Age 75 to 84 | 668 |
| Number Of Beneficiaries Age Greater 84 | 344 |
| Number Of Female Beneficiaries | 1354 |
| Number Of Male Beneficiaries | 997 |
| Number Of Non Hispanic White Beneficiaries | 2068 |
| Number Of Black or African American Beneficiaries | 35 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | 170 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1850 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 501 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5777 |