| National Provider Identifier [NPI]: | 1831292861 |
| Last Name Of The Provider | LACKOWSKI |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3600 N INTERSTATE AVE |
| Street Address 2 Of The Provider | INTERSTATE MEDICAL OFFICE CENTRAL |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 972271116 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Medical Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 4651 |
| Number Of Medicare Beneficiaries | 20 |
| Total Submitted Charge Amount | 124212.4 |
| Total Medicare Allowed Amount | 88606.21 |
| Total Medicare Payment Amount | 69153.06 |
| Total Medicare Standardized Payment Amount | 68696.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 25 |
| Number Of Drug Services | 4568 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 107110.4 |
| Total Drug Medicare AllowedAmount | 81814.29 |
| Total Drug Medicare PaymentAmount | 64112.72 |
| Total Drug Medicare Standardized Payment Amount | 64112.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 83 |
| Number Of Medicare Beneficiaries With Medical Services | 20 |
| Total Medical Submitted Charge Amount | 17102 |
| Total Medical Medicare Allowed Amount | 6791.92 |
| Total Medical Medicare Payment Amount | 5040.34 |
| Total Medical Medicare Standardized Payment Amount | 4583.79 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| 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 | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | |
| Percent Of With Hypertension | |
| Percent Of With Ischemic Heart Disease | 0 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 2.022 |