National Provider Identifier [NPI]: |
1215932033 |
Last Name Of The Provider |
LEE |
First Name Of The Provider |
MICHAEL |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2525 NW LOVEJOY ST |
Street Address 2 Of The Provider |
STE 100 |
City Of The Provider |
PORTLAND |
Zip Code Of The Provider |
972102861 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Ophthalmology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
45 |
Number Of Services |
9572 |
Number Of Medicare Beneficiaries |
548 |
Total Submitted Charge Amount |
2929556 |
Total Medicare Allowed Amount |
1376915.53 |
Total Medicare Payment Amount |
1058038.94 |
Total Medicare Standardized Payment Amount |
1053382.52 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
3794 |
Number Of Medicare Beneficiaries With Drug Services |
310 |
Total Drug Submitted ChargeAmount |
1301686 |
Total Drug Medicare AllowedAmount |
799172.79 |
Total Drug Medicare PaymentAmount |
625460.34 |
Total Drug Medicare Standardized Payment Amount |
625460.34 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
38 |
Number Of Medical Services |
5778 |
Number Of Medicare Beneficiaries With Medical Services |
548 |
Total Medical Submitted Charge Amount |
1627870 |
Total Medical Medicare Allowed Amount |
577742.74 |
Total Medical Medicare Payment Amount |
432578.6 |
Total Medical Medicare Standardized Payment Amount |
427922.18 |
Average Age Of Beneficiaries |
79 |
Number Of Beneficiaries Age Less65 |
40 |
Number Of Beneficiaries Age 65 to 74 |
143 |
Number Of Beneficiaries Age 75 to 84 |
178 |
Number Of Beneficiaries Age Greater 84 |
187 |
Number Of Female Beneficiaries |
341 |
Number Of Male Beneficiaries |
207 |
Number Of Non Hispanic White Beneficiaries |
489 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
19 |
Number Of Hispanic Beneficiaries |
19 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
457 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
91 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
13 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
27 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
20 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
44 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
28 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
28 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.4409 |