National Provider Identifier [NPI]: |
1629273594 |
Last Name Of The Provider |
KLYKOV |
First Name Of The Provider |
ARKADY |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1500 DIVISION STREET |
Street Address 2 Of The Provider |
|
City Of The Provider |
OREGON CITY |
Zip Code Of The Provider |
970451527 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
16 |
Number Of Services |
383 |
Number Of Medicare Beneficiaries |
204 |
Total Submitted Charge Amount |
127120 |
Total Medicare Allowed Amount |
40430.52 |
Total Medicare Payment Amount |
30918.75 |
Total Medicare Standardized Payment Amount |
30831.36 |
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 |
16 |
Number Of Medical Services |
383 |
Number Of Medicare Beneficiaries With Medical Services |
204 |
Total Medical Submitted Charge Amount |
127120 |
Total Medical Medicare Allowed Amount |
40430.52 |
Total Medical Medicare Payment Amount |
30918.75 |
Total Medical Medicare Standardized Payment Amount |
30831.36 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
29 |
Number Of Beneficiaries Age 65 to 74 |
59 |
Number Of Beneficiaries Age 75 to 84 |
57 |
Number Of Beneficiaries Age Greater 84 |
59 |
Number Of Female Beneficiaries |
123 |
Number Of Male Beneficiaries |
81 |
Number Of Non Hispanic White Beneficiaries |
192 |
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 |
134 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
70 |
Percent Of With Atrial Fibrillation |
23 |
Percent Of With Alzheimers Disease or Dementia |
30 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
41 |
Percent Of With Chronic Kidney Disease |
57 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
39 |
Percent Of With Hyperlipidemia |
52 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
48 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
15 |
Average HCC Risk Score Of Beneficiaries |
1.8337 |