| National Provider Identifier [NPI]: | 1184672024 |
| Last Name Of The Provider | DIVINE |
| First Name Of The Provider | RONALD |
| 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 | 1500 DIVISION ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | OREGON CITY |
| Zip Code Of The Provider | 970451527 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 116 |
| Number Of Services | 3890 |
| Number Of Medicare Beneficiaries | 2723 |
| Total Submitted Charge Amount | 313965.35 |
| Total Medicare Allowed Amount | 96751.53 |
| Total Medicare Payment Amount | 70391.33 |
| Total Medicare Standardized Payment Amount | 71278.37 |
| Drug Suppress Indicator | * |
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| Number Of Medicare Beneficiaries With Drug Services | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 608 |
| Number Of Beneficiaries Age 65 to 74 | 990 |
| Number Of Beneficiaries Age 75 to 84 | 679 |
| Number Of Beneficiaries Age Greater 84 | 446 |
| Number Of Female Beneficiaries | 1587 |
| Number Of Male Beneficiaries | 1136 |
| Number Of Non Hispanic White Beneficiaries | 2371 |
| Number Of Black or African American Beneficiaries | 108 |
| Number Of AsianPacific Islander Beneficiaries | 91 |
| Number Of Hispanic Beneficiaries | 84 |
| Number Of American Indian Alaska Native Beneficiaries | 24 |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1914 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 809 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5221 |