| National Provider Identifier [NPI]: | 1235199704 |
| Last Name Of The Provider | HENRIKSON |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3181 SW SAM JACKSON PARK RD |
| Street Address 2 Of The Provider | DIVISION OF CARDIOLOGY UHN 62 |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 972393011 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiac Electrophysiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 6119 |
| Number Of Medicare Beneficiaries | 3525 |
| Total Submitted Charge Amount | 470805.7 |
| Total Medicare Allowed Amount | 179104.38 |
| Total Medicare Payment Amount | 137353.13 |
| Total Medicare Standardized Payment Amount | 141211.71 |
| 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 | 73 |
| Number Of Medical Services | 6119 |
| Number Of Medicare Beneficiaries With Medical Services | 3525 |
| Total Medical Submitted Charge Amount | 470805.7 |
| Total Medical Medicare Allowed Amount | 179104.38 |
| Total Medical Medicare Payment Amount | 137353.13 |
| Total Medical Medicare Standardized Payment Amount | 141211.71 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 914 |
| Number Of Beneficiaries Age 65 to 74 | 1417 |
| Number Of Beneficiaries Age 75 to 84 | 826 |
| Number Of Beneficiaries Age Greater 84 | 368 |
| Number Of Female Beneficiaries | 1700 |
| Number Of Male Beneficiaries | 1825 |
| Number Of Non Hispanic White Beneficiaries | 3133 |
| Number Of Black or African American Beneficiaries | 94 |
| Number Of AsianPacific Islander Beneficiaries | 88 |
| Number Of Hispanic Beneficiaries | 107 |
| Number Of American Indian Alaska Native Beneficiaries | 38 |
| Number Of Beneficiaries With Race Not Else where Classified | 65 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2503 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1022 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7733 |