National Provider Identifier [NPI]: |
1326209131 |
Last Name Of The Provider |
OMIZO |
First Name Of The Provider |
MOLLY |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2200 NE NEFF RD |
Street Address 2 Of The Provider |
SUITE 302 |
City Of The Provider |
BEND |
Zip Code Of The Provider |
977014283 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
11 |
Number Of Services |
1654 |
Number Of Medicare Beneficiaries |
142 |
Total Submitted Charge Amount |
101632.93 |
Total Medicare Allowed Amount |
51098.28 |
Total Medicare Payment Amount |
38993.29 |
Total Medicare Standardized Payment Amount |
39980.6 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
1320 |
Number Of Medicare Beneficiaries With Drug Services |
17 |
Total Drug Submitted ChargeAmount |
25462.8 |
Total Drug Medicare AllowedAmount |
19019.28 |
Total Drug Medicare PaymentAmount |
14911.1 |
Total Drug Medicare Standardized Payment Amount |
14911.1 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
10 |
Number Of Medical Services |
334 |
Number Of Medicare Beneficiaries With Medical Services |
142 |
Total Medical Submitted Charge Amount |
76170.13 |
Total Medical Medicare Allowed Amount |
32079 |
Total Medical Medicare Payment Amount |
24082.19 |
Total Medical Medicare Standardized Payment Amount |
25069.5 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
73 |
Number Of Beneficiaries Age 75 to 84 |
51 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
128 |
Number Of Male Beneficiaries |
14 |
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 |
8 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
9 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
15 |
Percent Of With Diabetes |
8 |
Percent Of With Hyperlipidemia |
47 |
Percent Of With Hypertension |
38 |
Percent Of With Ischemic Heart Disease |
15 |
Percent Of With Osteoporosis |
75 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8778 |