National Provider Identifier [NPI]: |
1861746505 |
Last Name Of The Provider |
BOEING |
First Name Of The Provider |
KELLY |
Middle Initial Of The Provider |
F |
Credentials Of The Provider |
PA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3915 RIVER RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
EUGENE |
Zip Code Of The Provider |
974041230 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
79 |
Number Of Services |
1198 |
Number Of Medicare Beneficiaries |
300 |
Total Submitted Charge Amount |
142702 |
Total Medicare Allowed Amount |
46071.67 |
Total Medicare Payment Amount |
36112.54 |
Total Medicare Standardized Payment Amount |
43959.38 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
15 |
Number Of Drug Services |
103 |
Number Of Medicare Beneficiaries With Drug Services |
57 |
Total Drug Submitted ChargeAmount |
2892 |
Total Drug Medicare AllowedAmount |
2058.63 |
Total Drug Medicare PaymentAmount |
1996.84 |
Total Drug Medicare Standardized Payment Amount |
1996.84 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
64 |
Number Of Medical Services |
1095 |
Number Of Medicare Beneficiaries With Medical Services |
300 |
Total Medical Submitted Charge Amount |
139810 |
Total Medical Medicare Allowed Amount |
44013.04 |
Total Medical Medicare Payment Amount |
34115.7 |
Total Medical Medicare Standardized Payment Amount |
41962.54 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
38 |
Number Of Beneficiaries Age 65 to 74 |
135 |
Number Of Beneficiaries Age 75 to 84 |
75 |
Number Of Beneficiaries Age Greater 84 |
52 |
Number Of Female Beneficiaries |
155 |
Number Of Male Beneficiaries |
145 |
Number Of Non Hispanic White Beneficiaries |
280 |
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 |
254 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
46 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
19 |
Percent Of With Chronic Obstructive Pulmonary Disease |
6 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
24 |
Percent Of With Hyperlipidemia |
40 |
Percent Of With Hypertension |
49 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
29 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0662 |