| National Provider Identifier [NPI]: | 1023095585 |
| Last Name Of The Provider | CARLSON |
| First Name Of The Provider | VERA |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD, PHD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 169 N GATEWAY DR |
| Street Address 2 Of The Provider | 170 |
| City Of The Provider | PROVIDENCE |
| Zip Code Of The Provider | 843329707 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 1847 |
| Number Of Medicare Beneficiaries | 212 |
| Total Submitted Charge Amount | 117168.81 |
| Total Medicare Allowed Amount | 88614.89 |
| Total Medicare Payment Amount | 65256.32 |
| Total Medicare Standardized Payment Amount | 69690.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 83 |
| Number Of Medicare Beneficiaries With Drug Services | 68 |
| Total Drug Submitted ChargeAmount | 4855 |
| Total Drug Medicare AllowedAmount | 4075.78 |
| Total Drug Medicare PaymentAmount | 3994.08 |
| Total Drug Medicare Standardized Payment Amount | 3994.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 1764 |
| Number Of Medicare Beneficiaries With Medical Services | 212 |
| Total Medical Submitted Charge Amount | 112313.81 |
| Total Medical Medicare Allowed Amount | 84539.11 |
| Total Medical Medicare Payment Amount | 61262.24 |
| Total Medical Medicare Standardized Payment Amount | 65696.47 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 36 |
| Number Of Beneficiaries Age 65 to 74 | 101 |
| Number Of Beneficiaries Age 75 to 84 | 55 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 152 |
| Number Of Male Beneficiaries | 60 |
| 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 | 179 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 25 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 11 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9894 |