National Provider Identifier [NPI]: |
1972710556 |
Last Name Of The Provider |
CLEETON |
First Name Of The Provider |
REBECCA |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
DO |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
18040 SW LOWER BOONES FERRY RD |
Street Address 2 Of The Provider |
SUITE 100 |
City Of The Provider |
TIGARD |
Zip Code Of The Provider |
972247258 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
40 |
Number Of Services |
425 |
Number Of Medicare Beneficiaries |
151 |
Total Submitted Charge Amount |
89217 |
Total Medicare Allowed Amount |
29535.61 |
Total Medicare Payment Amount |
20348.02 |
Total Medicare Standardized Payment Amount |
20269.48 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
78 |
Number Of Medicare Beneficiaries With Drug Services |
38 |
Total Drug Submitted ChargeAmount |
1791 |
Total Drug Medicare AllowedAmount |
1123.39 |
Total Drug Medicare PaymentAmount |
1068.76 |
Total Drug Medicare Standardized Payment Amount |
1068.76 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
33 |
Number Of Medical Services |
347 |
Number Of Medicare Beneficiaries With Medical Services |
151 |
Total Medical Submitted Charge Amount |
87426 |
Total Medical Medicare Allowed Amount |
28412.22 |
Total Medical Medicare Payment Amount |
19279.26 |
Total Medical Medicare Standardized Payment Amount |
19200.72 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
16 |
Number Of Beneficiaries Age 65 to 74 |
82 |
Number Of Beneficiaries Age 75 to 84 |
32 |
Number Of Beneficiaries Age Greater 84 |
21 |
Number Of Female Beneficiaries |
113 |
Number Of Male Beneficiaries |
38 |
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 |
132 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
19 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
8 |
Percent Of With Chronic Kidney Disease |
12 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
25 |
Percent Of With Diabetes |
15 |
Percent Of With Hyperlipidemia |
47 |
Percent Of With Hypertension |
42 |
Percent Of With Ischemic Heart Disease |
16 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.823 |