| National Provider Identifier [NPI]: | 1104998962 |
| Last Name Of The Provider | MAHON |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 19300 SW 65TH |
| Street Address 2 Of The Provider | LEGACY MERIDIAN PARK HOSPITAL |
| City Of The Provider | TUALATIN |
| Zip Code Of The Provider | 970628854 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 178 |
| Number Of Services | 2765 |
| Number Of Medicare Beneficiaries | 1695 |
| Total Submitted Charge Amount | 272409 |
| Total Medicare Allowed Amount | 92201.47 |
| Total Medicare Payment Amount | 70526.89 |
| Total Medicare Standardized Payment Amount | 71087.15 |
| 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 | 178 |
| Number Of Medical Services | 2765 |
| Number Of Medicare Beneficiaries With Medical Services | 1695 |
| Total Medical Submitted Charge Amount | 272409 |
| Total Medical Medicare Allowed Amount | 92201.47 |
| Total Medical Medicare Payment Amount | 70526.89 |
| Total Medical Medicare Standardized Payment Amount | 71087.15 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 175 |
| Number Of Beneficiaries Age 65 to 74 | 615 |
| Number Of Beneficiaries Age 75 to 84 | 520 |
| Number Of Beneficiaries Age Greater 84 | 385 |
| Number Of Female Beneficiaries | 1020 |
| Number Of Male Beneficiaries | 675 |
| Number Of Non Hispanic White Beneficiaries | 1585 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| Number Of Hispanic Beneficiaries | 46 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1463 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 232 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4155 |