National Provider Identifier [NPI]: |
1952331795 |
Last Name Of The Provider |
DONAGHU |
First Name Of The Provider |
LAURA |
Middle Initial Of The Provider |
I |
Credentials Of The Provider |
|
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
5050 NE HOYT ST |
Street Address 2 Of The Provider |
SUITE 240 |
City Of The Provider |
PORTLAND |
Zip Code Of The Provider |
972132991 |
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 |
32 |
Number Of Services |
317 |
Number Of Medicare Beneficiaries |
78 |
Total Submitted Charge Amount |
64713 |
Total Medicare Allowed Amount |
21573.1 |
Total Medicare Payment Amount |
14190.5 |
Total Medicare Standardized Payment Amount |
14668.47 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
35 |
Number Of Medicare Beneficiaries With Drug Services |
27 |
Total Drug Submitted ChargeAmount |
2321 |
Total Drug Medicare AllowedAmount |
1489.76 |
Total Drug Medicare PaymentAmount |
1435.49 |
Total Drug Medicare Standardized Payment Amount |
1435.49 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
25 |
Number Of Medical Services |
282 |
Number Of Medicare Beneficiaries With Medical Services |
78 |
Total Medical Submitted Charge Amount |
62392 |
Total Medical Medicare Allowed Amount |
20083.34 |
Total Medical Medicare Payment Amount |
12755.01 |
Total Medical Medicare Standardized Payment Amount |
13232.98 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
42 |
Number Of Beneficiaries Age 75 to 84 |
17 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
62 |
Number Of Male Beneficiaries |
16 |
Number Of Non Hispanic White Beneficiaries |
65 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
0 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
66 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
12 |
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 |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
26 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
26 |
Percent Of With Hypertension |
47 |
Percent Of With Ischemic Heart Disease |
14 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8402 |