National Provider Identifier [NPI]: |
1588671820 |
Last Name Of The Provider |
BOOKER |
First Name Of The Provider |
MICHAEL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2647 NE 33RD AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
PORTLAND |
Zip Code Of The Provider |
972123647 |
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 |
68 |
Number Of Services |
1102 |
Number Of Medicare Beneficiaries |
108 |
Total Submitted Charge Amount |
71043.5 |
Total Medicare Allowed Amount |
32747.15 |
Total Medicare Payment Amount |
22852.41 |
Total Medicare Standardized Payment Amount |
23122.19 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
10 |
Number Of Drug Services |
127 |
Number Of Medicare Beneficiaries With Drug Services |
56 |
Total Drug Submitted ChargeAmount |
3063 |
Total Drug Medicare AllowedAmount |
2306.25 |
Total Drug Medicare PaymentAmount |
2024.06 |
Total Drug Medicare Standardized Payment Amount |
2024.06 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
58 |
Number Of Medical Services |
975 |
Number Of Medicare Beneficiaries With Medical Services |
108 |
Total Medical Submitted Charge Amount |
67980.5 |
Total Medical Medicare Allowed Amount |
30440.9 |
Total Medical Medicare Payment Amount |
20828.35 |
Total Medical Medicare Standardized Payment Amount |
21098.13 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
13 |
Number Of Beneficiaries Age 65 to 74 |
55 |
Number Of Beneficiaries Age 75 to 84 |
28 |
Number Of Beneficiaries Age Greater 84 |
12 |
Number Of Female Beneficiaries |
45 |
Number Of Male Beneficiaries |
63 |
Number Of Non Hispanic White Beneficiaries |
93 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
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 |
10 |
Percent Of With Chronic Kidney Disease |
19 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
12 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
20 |
Percent Of With Hypertension |
52 |
Percent Of With Ischemic Heart Disease |
22 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
20 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8113 |