| National Provider Identifier [NPI]: | 1649453390 |
| Last Name Of The Provider | BOHLKE |
| First Name Of The Provider | ANGELA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1793 13TH ST SE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALEM |
| Zip Code Of The Provider | 973022541 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 6 |
| Number Of Services | 4790 |
| Number Of Medicare Beneficiaries | 1819 |
| Total Submitted Charge Amount | 512325 |
| Total Medicare Allowed Amount | 184864.35 |
| Total Medicare Payment Amount | 140055.14 |
| Total Medicare Standardized Payment Amount | 104965.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 6 |
| Number Of Medical Services | 4790 |
| Number Of Medicare Beneficiaries With Medical Services | 1819 |
| Total Medical Submitted Charge Amount | 512325 |
| Total Medical Medicare Allowed Amount | 184864.35 |
| Total Medical Medicare Payment Amount | 140055.14 |
| Total Medical Medicare Standardized Payment Amount | 104965.66 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 154 |
| Number Of Beneficiaries Age 65 to 74 | 785 |
| Number Of Beneficiaries Age 75 to 84 | 575 |
| Number Of Beneficiaries Age Greater 84 | 305 |
| Number Of Female Beneficiaries | 864 |
| Number Of Male Beneficiaries | 955 |
| Number Of Non Hispanic White Beneficiaries | 1756 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1633 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 186 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0079 |