| National Provider Identifier [NPI]: | 1629030523 |
| Last Name Of The Provider | O'HOLLAREN |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2090 NE WYATT CT |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | BEND |
| Zip Code Of The Provider | 977017687 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 8435 |
| Number Of Medicare Beneficiaries | 1018 |
| Total Submitted Charge Amount | 1398990.47 |
| Total Medicare Allowed Amount | 333087.75 |
| Total Medicare Payment Amount | 241585.49 |
| Total Medicare Standardized Payment Amount | 249192.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 3840 |
| Number Of Medicare Beneficiaries With Drug Services | 70 |
| Total Drug Submitted ChargeAmount | 121848.51 |
| Total Drug Medicare AllowedAmount | 44531.39 |
| Total Drug Medicare PaymentAmount | 34160.7 |
| Total Drug Medicare Standardized Payment Amount | 34160.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 4595 |
| Number Of Medicare Beneficiaries With Medical Services | 1018 |
| Total Medical Submitted Charge Amount | 1277141.96 |
| Total Medical Medicare Allowed Amount | 288556.36 |
| Total Medical Medicare Payment Amount | 207424.79 |
| Total Medical Medicare Standardized Payment Amount | 215032.04 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 36 |
| Number Of Beneficiaries Age 65 to 74 | 467 |
| Number Of Beneficiaries Age 75 to 84 | 392 |
| Number Of Beneficiaries Age Greater 84 | 123 |
| Number Of Female Beneficiaries | 76 |
| Number Of Male Beneficiaries | 942 |
| Number Of Non Hispanic White Beneficiaries | 981 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 977 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 34 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.025 |