National Provider Identifier [NPI]: |
1962590570 |
Last Name Of The Provider |
SMITH |
First Name Of The Provider |
MATTHEW |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1130 NW 22ND AVE STE 410 |
Street Address 2 Of The Provider |
|
City Of The Provider |
PORTLAND |
Zip Code Of The Provider |
972102911 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Gastroenterology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
29 |
Number Of Services |
461 |
Number Of Medicare Beneficiaries |
172 |
Total Submitted Charge Amount |
208158 |
Total Medicare Allowed Amount |
59706.02 |
Total Medicare Payment Amount |
45827.74 |
Total Medicare Standardized Payment Amount |
45392.93 |
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 |
29 |
Number Of Medical Services |
461 |
Number Of Medicare Beneficiaries With Medical Services |
172 |
Total Medical Submitted Charge Amount |
208158 |
Total Medical Medicare Allowed Amount |
59706.02 |
Total Medical Medicare Payment Amount |
45827.74 |
Total Medical Medicare Standardized Payment Amount |
45392.93 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
49 |
Number Of Beneficiaries Age 65 to 74 |
73 |
Number Of Beneficiaries Age 75 to 84 |
39 |
Number Of Beneficiaries Age Greater 84 |
11 |
Number Of Female Beneficiaries |
86 |
Number Of Male Beneficiaries |
86 |
Number Of Non Hispanic White Beneficiaries |
145 |
Number Of Black or African American Beneficiaries |
12 |
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 |
104 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
68 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
26 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
34 |
Percent Of With Diabetes |
24 |
Percent Of With Hyperlipidemia |
40 |
Percent Of With Hypertension |
61 |
Percent Of With Ischemic Heart Disease |
30 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.5041 |