| National Provider Identifier [NPI]: | 1558302307 |
| Last Name Of The Provider | BACULI |
| First Name Of The Provider | RAYMOND |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1155 MISSION ST SE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALEM |
| Zip Code Of The Provider | 973026228 |
| 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 | 118 |
| Number Of Services | 1899 |
| Number Of Medicare Beneficiaries | 178 |
| Total Submitted Charge Amount | 120056 |
| Total Medicare Allowed Amount | 45989.92 |
| Total Medicare Payment Amount | 34174.94 |
| Total Medicare Standardized Payment Amount | 35527.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 409 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 3410 |
| Total Drug Medicare AllowedAmount | 865.79 |
| Total Drug Medicare PaymentAmount | 775.88 |
| Total Drug Medicare Standardized Payment Amount | 775.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 106 |
| Number Of Medical Services | 1490 |
| Number Of Medicare Beneficiaries With Medical Services | 178 |
| Total Medical Submitted Charge Amount | 116646 |
| Total Medical Medicare Allowed Amount | 45124.13 |
| Total Medical Medicare Payment Amount | 33399.06 |
| Total Medical Medicare Standardized Payment Amount | 34751.25 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 96 |
| Number Of Beneficiaries Age 65 to 74 | 44 |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 102 |
| Number Of Male Beneficiaries | 76 |
| Number Of Non Hispanic White Beneficiaries | 133 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 56 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 122 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 28 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1301 |