| National Provider Identifier [NPI]: | 1659388791 |
| Last Name Of The Provider | BOAM |
| First Name Of The Provider | W |
| 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 | 2655 W 9000 S |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEST JORDAN |
| Zip Code Of The Provider | 840888542 |
| 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 | 69 |
| Number Of Services | 913 |
| Number Of Medicare Beneficiaries | 131 |
| Total Submitted Charge Amount | 60334 |
| Total Medicare Allowed Amount | 33611.58 |
| Total Medicare Payment Amount | 24920.63 |
| Total Medicare Standardized Payment Amount | 26258.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 51 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 1606 |
| Total Drug Medicare AllowedAmount | 1426.85 |
| Total Drug Medicare PaymentAmount | 1390.31 |
| Total Drug Medicare Standardized Payment Amount | 1390.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 862 |
| Number Of Medicare Beneficiaries With Medical Services | 131 |
| Total Medical Submitted Charge Amount | 58728 |
| Total Medical Medicare Allowed Amount | 32184.73 |
| Total Medical Medicare Payment Amount | 23530.32 |
| Total Medical Medicare Standardized Payment Amount | 24868.41 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 65 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 69 |
| Number Of Male Beneficiaries | 62 |
| 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 | 120 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 26 |
| Percent Of With Hypertension | 40 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9657 |