National Provider Identifier [NPI]: |
1598741860 |
Last Name Of The Provider |
CANWELL |
First Name Of The Provider |
BRYAN |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
73265 CONFEDERATED WAY |
Street Address 2 Of The Provider |
|
City Of The Provider |
PENDLETON |
Zip Code Of The Provider |
97801 |
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 |
46 |
Number Of Services |
772 |
Number Of Medicare Beneficiaries |
92 |
Total Submitted Charge Amount |
57041.96 |
Total Medicare Allowed Amount |
21828.17 |
Total Medicare Payment Amount |
16114.64 |
Total Medicare Standardized Payment Amount |
19069.77 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
11 |
Number Of Drug Services |
132 |
Number Of Medicare Beneficiaries With Drug Services |
45 |
Total Drug Submitted ChargeAmount |
2209.96 |
Total Drug Medicare AllowedAmount |
713.89 |
Total Drug Medicare PaymentAmount |
649.79 |
Total Drug Medicare Standardized Payment Amount |
649.79 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
35 |
Number Of Medical Services |
640 |
Number Of Medicare Beneficiaries With Medical Services |
92 |
Total Medical Submitted Charge Amount |
54832 |
Total Medical Medicare Allowed Amount |
21114.28 |
Total Medical Medicare Payment Amount |
15464.85 |
Total Medical Medicare Standardized Payment Amount |
18419.98 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
37 |
Number Of Beneficiaries Age 75 to 84 |
26 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
52 |
Number Of Male Beneficiaries |
40 |
Number Of Non Hispanic White Beneficiaries |
0 |
Number Of Black or African American Beneficiaries |
0 |
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
0 |
Number Of American Indian Alaska Native Beneficiaries |
92 |
Number Of Beneficiaries With Race Not Else where Classified |
0 |
Number Of Beneficiaries With Medicare Only Entitlement |
65 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
27 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
23 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
16 |
Percent Of With Diabetes |
53 |
Percent Of With Hyperlipidemia |
41 |
Percent Of With Hypertension |
55 |
Percent Of With Ischemic Heart Disease |
28 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
39 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.3608 |