National Provider Identifier [NPI]: |
1245421551 |
Last Name Of The Provider |
LEE |
First Name Of The Provider |
BOB |
Middle Initial Of The Provider |
Y |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
827 SPRING ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
MEDFORD |
Zip Code Of The Provider |
975046111 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physical Medicine and Rehabilitation |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
41 |
Number Of Services |
4863 |
Number Of Medicare Beneficiaries |
309 |
Total Submitted Charge Amount |
482452 |
Total Medicare Allowed Amount |
155881.2 |
Total Medicare Payment Amount |
112369.07 |
Total Medicare Standardized Payment Amount |
107730.77 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
3592 |
Number Of Medicare Beneficiaries With Drug Services |
65 |
Total Drug Submitted ChargeAmount |
27950 |
Total Drug Medicare AllowedAmount |
17931.72 |
Total Drug Medicare PaymentAmount |
9346.92 |
Total Drug Medicare Standardized Payment Amount |
9346.92 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
39 |
Number Of Medical Services |
1271 |
Number Of Medicare Beneficiaries With Medical Services |
309 |
Total Medical Submitted Charge Amount |
454502 |
Total Medical Medicare Allowed Amount |
137949.48 |
Total Medical Medicare Payment Amount |
103022.15 |
Total Medical Medicare Standardized Payment Amount |
98383.85 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
73 |
Number Of Beneficiaries Age 65 to 74 |
132 |
Number Of Beneficiaries Age 75 to 84 |
76 |
Number Of Beneficiaries Age Greater 84 |
28 |
Number Of Female Beneficiaries |
162 |
Number Of Male Beneficiaries |
147 |
Number Of Non Hispanic White Beneficiaries |
294 |
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 |
228 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
81 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
17 |
Percent Of With Chronic Kidney Disease |
19 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
57 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
52 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
16 |
Average HCC Risk Score Of Beneficiaries |
1.2486 |