National Provider Identifier [NPI]: |
1760649024 |
Last Name Of The Provider |
COURTNEY |
First Name Of The Provider |
ROBERT |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3375 SW TERWILLIGER BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
PORTLAND |
Zip Code Of The Provider |
972394146 |
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 |
36 |
Number Of Services |
653 |
Number Of Medicare Beneficiaries |
189 |
Total Submitted Charge Amount |
250682.5 |
Total Medicare Allowed Amount |
88342.74 |
Total Medicare Payment Amount |
67370.87 |
Total Medicare Standardized Payment Amount |
67428.61 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
66 |
Number Of Medicare Beneficiaries With Drug Services |
21 |
Total Drug Submitted ChargeAmount |
23961 |
Total Drug Medicare AllowedAmount |
11983.78 |
Total Drug Medicare PaymentAmount |
9395.25 |
Total Drug Medicare Standardized Payment Amount |
9395.25 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
34 |
Number Of Medical Services |
587 |
Number Of Medicare Beneficiaries With Medical Services |
189 |
Total Medical Submitted Charge Amount |
226721.5 |
Total Medical Medicare Allowed Amount |
76358.96 |
Total Medical Medicare Payment Amount |
57975.62 |
Total Medical Medicare Standardized Payment Amount |
58033.36 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
38 |
Number Of Beneficiaries Age 65 to 74 |
79 |
Number Of Beneficiaries Age 75 to 84 |
51 |
Number Of Beneficiaries Age Greater 84 |
21 |
Number Of Female Beneficiaries |
94 |
Number Of Male Beneficiaries |
95 |
Number Of Non Hispanic White Beneficiaries |
124 |
Number Of Black or African American Beneficiaries |
41 |
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 |
121 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
68 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
25 |
Percent Of With Chronic Kidney Disease |
30 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
21 |
Percent Of With Diabetes |
43 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.8288 |