| National Provider Identifier [NPI]: | 1760583389 |
| Last Name Of The Provider | D'AVIGNON |
| First Name Of The Provider | LOUIS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1501 NE MEDICAL CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | BEND |
| Zip Code Of The Provider | 977016051 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 75 |
| Number Of Services | 2626 |
| Number Of Medicare Beneficiaries | 516 |
| Total Submitted Charge Amount | 713359.16 |
| Total Medicare Allowed Amount | 186997.63 |
| Total Medicare Payment Amount | 143517.21 |
| Total Medicare Standardized Payment Amount | 149348.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 566 |
| Number Of Medicare Beneficiaries With Drug Services | 172 |
| Total Drug Submitted ChargeAmount | 11954.41 |
| Total Drug Medicare AllowedAmount | 4082.72 |
| Total Drug Medicare PaymentAmount | 3996.02 |
| Total Drug Medicare Standardized Payment Amount | 3996.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 69 |
| Number Of Medical Services | 2060 |
| Number Of Medicare Beneficiaries With Medical Services | 516 |
| Total Medical Submitted Charge Amount | 701404.75 |
| Total Medical Medicare Allowed Amount | 182914.91 |
| Total Medical Medicare Payment Amount | 139521.19 |
| Total Medical Medicare Standardized Payment Amount | 145352.84 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 234 |
| Number Of Beneficiaries Age 75 to 84 | 157 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 268 |
| Number Of Male Beneficiaries | 248 |
| Number Of Non Hispanic White Beneficiaries | 483 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 428 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 88 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 46 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6164 |