| National Provider Identifier [NPI]: | 1922001536 |
| Last Name Of The Provider | MYKLEBUST |
| First Name Of The Provider | ERIN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | ANP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9135 SW BARNES RD |
| Street Address 2 Of The Provider | STE 261 |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 972256601 |
| 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 | 37 |
| Number Of Services | 2194 |
| Number Of Medicare Beneficiaries | 28 |
| Total Submitted Charge Amount | 44091 |
| Total Medicare Allowed Amount | 22633.61 |
| Total Medicare Payment Amount | 17672.73 |
| Total Medicare Standardized Payment Amount | 18199.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 20 |
| Number Of Drug Services | 2113 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 28233 |
| Total Drug Medicare AllowedAmount | 18376.2 |
| Total Drug Medicare PaymentAmount | 14406.94 |
| Total Drug Medicare Standardized Payment Amount | 14406.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 81 |
| Number Of Medicare Beneficiaries With Medical Services | 27 |
| Total Medical Submitted Charge Amount | 15858 |
| Total Medical Medicare Allowed Amount | 4257.41 |
| Total Medical Medicare Payment Amount | 3265.79 |
| Total Medical Medicare Standardized Payment Amount | 3792.11 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 13 |
| 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 | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 43 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.8441 |