| National Provider Identifier [NPI]: | 1760659130 |
| Last Name Of The Provider | BOTT |
| First Name Of The Provider | WESLEY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 325 W CENTER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPANISH FORK |
| Zip Code Of The Provider | 846602060 |
| 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 | 88 |
| Number Of Services | 1715 |
| Number Of Medicare Beneficiaries | 375 |
| Total Submitted Charge Amount | 129192.5 |
| Total Medicare Allowed Amount | 96795.4 |
| Total Medicare Payment Amount | 68336.09 |
| Total Medicare Standardized Payment Amount | 71752.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 454 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 6005.5 |
| Total Drug Medicare AllowedAmount | 3851.29 |
| Total Drug Medicare PaymentAmount | 3158.66 |
| Total Drug Medicare Standardized Payment Amount | 3158.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 1261 |
| Number Of Medicare Beneficiaries With Medical Services | 375 |
| Total Medical Submitted Charge Amount | 123187 |
| Total Medical Medicare Allowed Amount | 92944.11 |
| Total Medical Medicare Payment Amount | 65177.43 |
| Total Medical Medicare Standardized Payment Amount | 68593.4 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 125 |
| Number Of Beneficiaries Age 75 to 84 | 116 |
| Number Of Beneficiaries Age Greater 84 | 104 |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 235 |
| Number Of Non Hispanic White Beneficiaries | 362 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 335 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 35 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3159 |