| National Provider Identifier [NPI]: | 1467468132 |
| Last Name Of The Provider | WADDICK |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4104 SE 82ND AVE |
| Street Address 2 Of The Provider | SUITE 250 |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 972662954 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 284 |
| Number Of Medicare Beneficiaries | 118 |
| Total Submitted Charge Amount | 59576 |
| Total Medicare Allowed Amount | 19363.58 |
| Total Medicare Payment Amount | 13443.78 |
| Total Medicare Standardized Payment Amount | 13388.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 926 |
| Total Drug Medicare AllowedAmount | 596.24 |
| Total Drug Medicare PaymentAmount | 581.49 |
| Total Drug Medicare Standardized Payment Amount | 581.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 264 |
| Number Of Medicare Beneficiaries With Medical Services | 118 |
| Total Medical Submitted Charge Amount | 58650 |
| Total Medical Medicare Allowed Amount | 18767.34 |
| Total Medical Medicare Payment Amount | 12862.29 |
| Total Medical Medicare Standardized Payment Amount | 12806.63 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 40 |
| Number Of Beneficiaries Age 75 to 84 | 26 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 70 |
| Number Of Male Beneficiaries | 48 |
| Number Of Non Hispanic White Beneficiaries | 84 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| 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 | 42 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 76 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3779 |