| National Provider Identifier [NPI]: | 1497722219 |
| Last Name Of The Provider | CULLEN |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 551 LONE PINE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | THE DALLES |
| Zip Code Of The Provider | 97058 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 1162 |
| Number Of Medicare Beneficiaries | 176 |
| Total Submitted Charge Amount | 229047.6 |
| Total Medicare Allowed Amount | 101025.77 |
| Total Medicare Payment Amount | 76677.59 |
| Total Medicare Standardized Payment Amount | 79261.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 594 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 18324.6 |
| Total Drug Medicare AllowedAmount | 13388.83 |
| Total Drug Medicare PaymentAmount | 10493.39 |
| Total Drug Medicare Standardized Payment Amount | 10493.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 568 |
| Number Of Medicare Beneficiaries With Medical Services | 176 |
| Total Medical Submitted Charge Amount | 210723 |
| Total Medical Medicare Allowed Amount | 87636.94 |
| Total Medical Medicare Payment Amount | 66184.2 |
| Total Medical Medicare Standardized Payment Amount | 68767.77 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 74 |
| Number Of Beneficiaries Age 75 to 84 | 46 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 106 |
| Number Of Male Beneficiaries | 70 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 132 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 44 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 62 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1261 |