| National Provider Identifier [NPI]: | 1467565671 |
| Last Name Of The Provider | MAYBERRY |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 233 NE 102ND AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 97220 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 157 |
| Number Of Services | 5483 |
| Number Of Medicare Beneficiaries | 3504 |
| Total Submitted Charge Amount | 584437.56 |
| Total Medicare Allowed Amount | 191767.79 |
| Total Medicare Payment Amount | 154699.24 |
| Total Medicare Standardized Payment Amount | 150662.44 |
| 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 | 157 |
| Number Of Medical Services | 5483 |
| Number Of Medicare Beneficiaries With Medical Services | 3504 |
| Total Medical Submitted Charge Amount | 584437.56 |
| Total Medical Medicare Allowed Amount | 191767.79 |
| Total Medical Medicare Payment Amount | 154699.24 |
| Total Medical Medicare Standardized Payment Amount | 150662.44 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 486 |
| Number Of Beneficiaries Age 65 to 74 | 1275 |
| Number Of Beneficiaries Age 75 to 84 | 1070 |
| Number Of Beneficiaries Age Greater 84 | 673 |
| Number Of Female Beneficiaries | 2578 |
| Number Of Male Beneficiaries | 926 |
| Number Of Non Hispanic White Beneficiaries | 2720 |
| Number Of Black or African American Beneficiaries | 108 |
| Number Of AsianPacific Islander Beneficiaries | 182 |
| Number Of Hispanic Beneficiaries | 426 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 57 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2653 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 851 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5314 |