| National Provider Identifier [NPI]: | 1255329728 |
| Last Name Of The Provider | DAUTERMAN |
| First Name Of The Provider | KENT |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 520 MEDICAL CENTER DR |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | MEDFORD |
| Zip Code Of The Provider | 975044314 |
| 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 | 60 |
| Number Of Services | 3164 |
| Number Of Medicare Beneficiaries | 1409 |
| Total Submitted Charge Amount | 884392.78 |
| Total Medicare Allowed Amount | 291863.5 |
| Total Medicare Payment Amount | 215736.74 |
| Total Medicare Standardized Payment Amount | 226145.99 |
| 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 | 60 |
| Number Of Medical Services | 3164 |
| Number Of Medicare Beneficiaries With Medical Services | 1409 |
| Total Medical Submitted Charge Amount | 884392.78 |
| Total Medical Medicare Allowed Amount | 291863.5 |
| Total Medical Medicare Payment Amount | 215736.74 |
| Total Medical Medicare Standardized Payment Amount | 226145.99 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 157 |
| Number Of Beneficiaries Age 65 to 74 | 575 |
| Number Of Beneficiaries Age 75 to 84 | 462 |
| Number Of Beneficiaries Age Greater 84 | 215 |
| Number Of Female Beneficiaries | 645 |
| Number Of Male Beneficiaries | 764 |
| Number Of Non Hispanic White Beneficiaries | 1329 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | 16 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1164 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 245 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4291 |