| National Provider Identifier [NPI]: | 1699712182 |
| Last Name Of The Provider | LEVISOHN |
| First Name Of The Provider | DIANNE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2011 NW MYHRE PL |
| Street Address 2 Of The Provider | |
| City Of The Provider | SILVERDALE |
| Zip Code Of The Provider | 983838561 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 109 |
| Number Of Services | 10213 |
| Number Of Medicare Beneficiaries | 1524 |
| Total Submitted Charge Amount | 1523480.8 |
| Total Medicare Allowed Amount | 696985.51 |
| Total Medicare Payment Amount | 511043.2 |
| Total Medicare Standardized Payment Amount | 497333.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 297 |
| Number Of Medicare Beneficiaries With Drug Services | 130 |
| Total Drug Submitted ChargeAmount | 93797.8 |
| Total Drug Medicare AllowedAmount | 71488.6 |
| Total Drug Medicare PaymentAmount | 55705.4 |
| Total Drug Medicare Standardized Payment Amount | 55705.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 107 |
| Number Of Medical Services | 9916 |
| Number Of Medicare Beneficiaries With Medical Services | 1524 |
| Total Medical Submitted Charge Amount | 1429683 |
| Total Medical Medicare Allowed Amount | 625496.91 |
| Total Medical Medicare Payment Amount | 455337.8 |
| Total Medical Medicare Standardized Payment Amount | 441628.49 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 814 |
| Number Of Beneficiaries Age 75 to 84 | 493 |
| Number Of Beneficiaries Age Greater 84 | 176 |
| Number Of Female Beneficiaries | 934 |
| Number Of Male Beneficiaries | 590 |
| Number Of Non Hispanic White Beneficiaries | 1485 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1472 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8734 |