| National Provider Identifier [NPI]: | 1184872665 |
| Last Name Of The Provider | DENISON |
| First Name Of The Provider | SHELLEY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | RN, ANP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 507 NE 47TH AVE |
| Street Address 2 Of The Provider | #210 |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 972132236 |
| 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 | 21 |
| Number Of Services | 371 |
| Number Of Medicare Beneficiaries | 43 |
| Total Submitted Charge Amount | 100362 |
| Total Medicare Allowed Amount | 50143.52 |
| Total Medicare Payment Amount | 38265.03 |
| Total Medicare Standardized Payment Amount | 44818.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 23 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 1030 |
| Total Drug Medicare AllowedAmount | 791.35 |
| Total Drug Medicare PaymentAmount | 775.47 |
| Total Drug Medicare Standardized Payment Amount | 775.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 348 |
| Number Of Medicare Beneficiaries With Medical Services | 43 |
| Total Medical Submitted Charge Amount | 99332 |
| Total Medical Medicare Allowed Amount | 49352.17 |
| Total Medical Medicare Payment Amount | 37489.56 |
| Total Medical Medicare Standardized Payment Amount | 44043.07 |
| Average Age Of Beneficiaries | 83 |
| 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 | 23 |
| Number Of Female Beneficiaries | 31 |
| Number Of Male Beneficiaries | 12 |
| 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 | |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 0 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.8239 |