| National Provider Identifier [NPI]: | 1184913147 |
| Last Name Of The Provider | LAWRENCE |
| First Name Of The Provider | JERRY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11705 NW TIMBERVIEW LN |
| Street Address 2 Of The Provider | APT 204 |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 972296659 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 1375 |
| Number Of Medicare Beneficiaries | 820 |
| Total Submitted Charge Amount | 1021576 |
| Total Medicare Allowed Amount | 142590.69 |
| Total Medicare Payment Amount | 110184.98 |
| Total Medicare Standardized Payment Amount | 114584.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 1375 |
| Number Of Medicare Beneficiaries With Medical Services | 820 |
| Total Medical Submitted Charge Amount | 1021576 |
| Total Medical Medicare Allowed Amount | 142590.69 |
| Total Medical Medicare Payment Amount | 110184.98 |
| Total Medical Medicare Standardized Payment Amount | 114584.36 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 244 |
| Number Of Beneficiaries Age 65 to 74 | 215 |
| Number Of Beneficiaries Age 75 to 84 | 202 |
| Number Of Beneficiaries Age Greater 84 | 159 |
| Number Of Female Beneficiaries | 493 |
| Number Of Male Beneficiaries | 327 |
| Number Of Non Hispanic White Beneficiaries | 767 |
| Number Of Black or African American Beneficiaries | 39 |
| 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 | 470 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 350 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 41 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.9379 |