| National Provider Identifier [NPI]: | 1922288588 |
| Last Name Of The Provider | SAMUELSON |
| First Name Of The Provider | SCOTT |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 333 S 900 E |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841022310 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 116 |
| Number Of Services | 35753 |
| Number Of Medicare Beneficiaries | 341 |
| Total Submitted Charge Amount | 3271248.5 |
| Total Medicare Allowed Amount | 846527.95 |
| Total Medicare Payment Amount | 659343.8 |
| Total Medicare Standardized Payment Amount | 672409.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 43 |
| Number Of Drug Services | 30547 |
| Number Of Medicare Beneficiaries With Drug Services | 71 |
| Total Drug Submitted ChargeAmount | 2739309.5 |
| Total Drug Medicare AllowedAmount | 629584.37 |
| Total Drug Medicare PaymentAmount | 490068.08 |
| Total Drug Medicare Standardized Payment Amount | 490068.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 73 |
| Number Of Medical Services | 5206 |
| Number Of Medicare Beneficiaries With Medical Services | 341 |
| Total Medical Submitted Charge Amount | 531939 |
| Total Medical Medicare Allowed Amount | 216943.58 |
| Total Medical Medicare Payment Amount | 169275.72 |
| Total Medical Medicare Standardized Payment Amount | 182341.77 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 114 |
| Number Of Beneficiaries Age 75 to 84 | 125 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 171 |
| Number Of Male Beneficiaries | 170 |
| Number Of Non Hispanic White Beneficiaries | 312 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 312 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 29 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 38 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.6186 |