| National Provider Identifier [NPI]: | 1467445536 |
| Last Name Of The Provider | WELBORN |
| First Name Of The Provider | JODY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1111 NE 99TH AVE |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 972209428 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 1150 |
| Number Of Medicare Beneficiaries | 583 |
| Total Submitted Charge Amount | 233652 |
| Total Medicare Allowed Amount | 69727.93 |
| Total Medicare Payment Amount | 51515.58 |
| Total Medicare Standardized Payment Amount | 51110.32 |
| 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 | 36 |
| Number Of Medical Services | 1150 |
| Number Of Medicare Beneficiaries With Medical Services | 583 |
| Total Medical Submitted Charge Amount | 233652 |
| Total Medical Medicare Allowed Amount | 69727.93 |
| Total Medical Medicare Payment Amount | 51515.58 |
| Total Medical Medicare Standardized Payment Amount | 51110.32 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 75 |
| Number Of Beneficiaries Age 65 to 74 | 193 |
| Number Of Beneficiaries Age 75 to 84 | 202 |
| Number Of Beneficiaries Age Greater 84 | 113 |
| Number Of Female Beneficiaries | 303 |
| Number Of Male Beneficiaries | 280 |
| Number Of Non Hispanic White Beneficiaries | 508 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 462 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 121 |
| Percent Of With Atrial Fibrillation | 33 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5515 |