National Provider Identifier [NPI]: |
1144235656 |
Last Name Of The Provider |
SHAFF-CHIN |
First Name Of The Provider |
CYNTHIA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
5330 NE GLISAN ST |
Street Address 2 Of The Provider |
STE 100 |
City Of The Provider |
PORTLAND |
Zip Code Of The Provider |
972133069 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
22 |
Number Of Services |
137 |
Number Of Medicare Beneficiaries |
57 |
Total Submitted Charge Amount |
26861 |
Total Medicare Allowed Amount |
8898.35 |
Total Medicare Payment Amount |
6016.72 |
Total Medicare Standardized Payment Amount |
5935.36 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
12 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
741 |
Total Drug Medicare AllowedAmount |
471.07 |
Total Drug Medicare PaymentAmount |
461.65 |
Total Drug Medicare Standardized Payment Amount |
461.65 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
18 |
Number Of Medical Services |
125 |
Number Of Medicare Beneficiaries With Medical Services |
57 |
Total Medical Submitted Charge Amount |
26120 |
Total Medical Medicare Allowed Amount |
8427.28 |
Total Medical Medicare Payment Amount |
5555.07 |
Total Medical Medicare Standardized Payment Amount |
5473.71 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
36 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
42 |
Number Of Male Beneficiaries |
15 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
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 |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
21 |
Percent Of With Diabetes |
21 |
Percent Of With Hyperlipidemia |
44 |
Percent Of With Hypertension |
49 |
Percent Of With Ischemic Heart Disease |
|
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
25 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2854 |