| National Provider Identifier [NPI]: | 1205828936 |
| Last Name Of The Provider | GRISWOLD |
| First Name Of The Provider | ROXANNE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4805 NE GLISAN ST |
| Street Address 2 Of The Provider | STE 6N40 |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 972132933 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 1277 |
| Number Of Medicare Beneficiaries | 24 |
| Total Submitted Charge Amount | 84877 |
| Total Medicare Allowed Amount | 51042.3 |
| Total Medicare Payment Amount | 39928.41 |
| Total Medicare Standardized Payment Amount | 40299.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 27 |
| Number Of Drug Services | 1198 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 70657 |
| Total Drug Medicare AllowedAmount | 47145.66 |
| Total Drug Medicare PaymentAmount | 36961.35 |
| Total Drug Medicare Standardized Payment Amount | 36961.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 79 |
| Number Of Medicare Beneficiaries With Medical Services | 23 |
| Total Medical Submitted Charge Amount | 14220 |
| Total Medical Medicare Allowed Amount | 3896.64 |
| Total Medical Medicare Payment Amount | 2967.06 |
| Total Medical Medicare Standardized Payment Amount | 3338.47 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | 0 |
| Percent Of With Asthma | 0 |
| Percent Of With Cancer | 50 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | |
| Percent Of With Hypertension | |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 2.5025 |