National Provider Identifier [NPI]: |
1942304464 |
Last Name Of The Provider |
SAULINO |
First Name Of The Provider |
EVAN |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4104 SE 82ND AVE |
Street Address 2 Of The Provider |
SUITE 250 |
City Of The Provider |
PORTLAND |
Zip Code Of The Provider |
972662954 |
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 |
25 |
Number Of Services |
225 |
Number Of Medicare Beneficiaries |
90 |
Total Submitted Charge Amount |
45976 |
Total Medicare Allowed Amount |
14924.87 |
Total Medicare Payment Amount |
10289.41 |
Total Medicare Standardized Payment Amount |
10315.65 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
17 |
Number Of Medicare Beneficiaries With Drug Services |
11 |
Total Drug Submitted ChargeAmount |
864 |
Total Drug Medicare AllowedAmount |
557.07 |
Total Drug Medicare PaymentAmount |
545.82 |
Total Drug Medicare Standardized Payment Amount |
545.82 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
21 |
Number Of Medical Services |
208 |
Number Of Medicare Beneficiaries With Medical Services |
90 |
Total Medical Submitted Charge Amount |
45112 |
Total Medical Medicare Allowed Amount |
14367.8 |
Total Medical Medicare Payment Amount |
9743.59 |
Total Medical Medicare Standardized Payment Amount |
9769.83 |
Average Age Of Beneficiaries |
63 |
Number Of Beneficiaries Age Less65 |
39 |
Number Of Beneficiaries Age 65 to 74 |
34 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
45 |
Number Of Male Beneficiaries |
45 |
Number Of Non Hispanic White Beneficiaries |
58 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
13 |
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 |
39 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
51 |
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 |
17 |
Percent Of With Chronic Kidney Disease |
18 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
28 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
30 |
Percent Of With Hypertension |
52 |
Percent Of With Ischemic Heart Disease |
14 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
23 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0507 |