| National Provider Identifier [NPI]: | 1609980713 |
| Last Name Of The Provider | THERIAULT |
| First Name Of The Provider | ALEXANDRA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1420 W CANAL CT |
| Street Address 2 Of The Provider | #50 |
| City Of The Provider | LITTLETON |
| Zip Code Of The Provider | 801205655 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 3172 |
| Number Of Medicare Beneficiaries | 882 |
| Total Submitted Charge Amount | 276726 |
| Total Medicare Allowed Amount | 203692.84 |
| Total Medicare Payment Amount | 137685.7 |
| Total Medicare Standardized Payment Amount | 135034.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 60 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 3360 |
| Total Drug Medicare AllowedAmount | 2326.16 |
| Total Drug Medicare PaymentAmount | 1470.95 |
| Total Drug Medicare Standardized Payment Amount | 1470.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 3112 |
| Number Of Medicare Beneficiaries With Medical Services | 882 |
| Total Medical Submitted Charge Amount | 273366 |
| Total Medical Medicare Allowed Amount | 201366.68 |
| Total Medical Medicare Payment Amount | 136214.75 |
| Total Medical Medicare Standardized Payment Amount | 133564.03 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 537 |
| Number Of Beneficiaries Age 75 to 84 | 241 |
| Number Of Beneficiaries Age Greater 84 | 81 |
| Number Of Female Beneficiaries | 533 |
| Number Of Male Beneficiaries | 349 |
| Number Of Non Hispanic White Beneficiaries | 850 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 14 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.7696 |