National Provider Identifier [NPI]: |
1356399190 |
Last Name Of The Provider |
CHANCE |
First Name Of The Provider |
STACY |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
330 S GARDEN WAY |
Street Address 2 Of The Provider |
SUITE 350 |
City Of The Provider |
EUGENE |
Zip Code Of The Provider |
974018176 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
73 |
Number Of Services |
2704 |
Number Of Medicare Beneficiaries |
604 |
Total Submitted Charge Amount |
189474 |
Total Medicare Allowed Amount |
70838.33 |
Total Medicare Payment Amount |
52857.28 |
Total Medicare Standardized Payment Amount |
55236.29 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
11 |
Number Of Drug Services |
82 |
Number Of Medicare Beneficiaries With Drug Services |
52 |
Total Drug Submitted ChargeAmount |
2013 |
Total Drug Medicare AllowedAmount |
1334.48 |
Total Drug Medicare PaymentAmount |
1290.9 |
Total Drug Medicare Standardized Payment Amount |
1290.9 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
62 |
Number Of Medical Services |
2622 |
Number Of Medicare Beneficiaries With Medical Services |
604 |
Total Medical Submitted Charge Amount |
187461 |
Total Medical Medicare Allowed Amount |
69503.85 |
Total Medical Medicare Payment Amount |
51566.38 |
Total Medical Medicare Standardized Payment Amount |
53945.39 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
59 |
Number Of Beneficiaries Age 65 to 74 |
224 |
Number Of Beneficiaries Age 75 to 84 |
188 |
Number Of Beneficiaries Age Greater 84 |
133 |
Number Of Female Beneficiaries |
333 |
Number Of Male Beneficiaries |
271 |
Number Of Non Hispanic White Beneficiaries |
582 |
Number Of Black or African American Beneficiaries |
|
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 |
537 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
67 |
Percent Of With Atrial Fibrillation |
48 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
27 |
Percent Of With Chronic Kidney Disease |
26 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
24 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
52 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
30 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
2 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.2897 |