National Provider Identifier [NPI]: |
1588690820 |
Last Name Of The Provider |
KHARY |
First Name Of The Provider |
VICTORYA |
Middle Initial Of The Provider |
V |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
417 SW 117TH AVE |
Street Address 2 Of The Provider |
2ND FLOOR |
City Of The Provider |
PORTLAND |
Zip Code Of The Provider |
972255924 |
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 |
36 |
Number Of Services |
549 |
Number Of Medicare Beneficiaries |
232 |
Total Submitted Charge Amount |
124247 |
Total Medicare Allowed Amount |
40468.87 |
Total Medicare Payment Amount |
26879.61 |
Total Medicare Standardized Payment Amount |
26614.87 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
44 |
Number Of Medicare Beneficiaries With Drug Services |
21 |
Total Drug Submitted ChargeAmount |
1250 |
Total Drug Medicare AllowedAmount |
814.06 |
Total Drug Medicare PaymentAmount |
763.99 |
Total Drug Medicare Standardized Payment Amount |
763.99 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
27 |
Number Of Medical Services |
505 |
Number Of Medicare Beneficiaries With Medical Services |
232 |
Total Medical Submitted Charge Amount |
122997 |
Total Medical Medicare Allowed Amount |
39654.81 |
Total Medical Medicare Payment Amount |
26115.62 |
Total Medical Medicare Standardized Payment Amount |
25850.88 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
17 |
Number Of Beneficiaries Age 65 to 74 |
106 |
Number Of Beneficiaries Age 75 to 84 |
76 |
Number Of Beneficiaries Age Greater 84 |
33 |
Number Of Female Beneficiaries |
189 |
Number Of Male Beneficiaries |
43 |
Number Of Non Hispanic White Beneficiaries |
221 |
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 |
205 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
27 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
|
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
6 |
Percent Of With Depression |
15 |
Percent Of With Diabetes |
16 |
Percent Of With Hyperlipidemia |
39 |
Percent Of With Hypertension |
44 |
Percent Of With Ischemic Heart Disease |
22 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
0.9395 |