| National Provider Identifier [NPI]: | 1134101397 |
| Last Name Of The Provider | THORNBURG |
| First Name Of The Provider | LESLIE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | OD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | W7164 GREEN VALLEY RD |
| Street Address 2 Of The Provider | INDIANHEAD EYE CLINIC |
| City Of The Provider | SPOONER |
| Zip Code Of The Provider | 548016605 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 1539 |
| Number Of Medicare Beneficiaries | 506 |
| Total Submitted Charge Amount | 59058 |
| Total Medicare Allowed Amount | 52232.89 |
| Total Medicare Payment Amount | 31265.49 |
| Total Medicare Standardized Payment Amount | 34257.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 1539 |
| Number Of Medicare Beneficiaries With Medical Services | 506 |
| Total Medical Submitted Charge Amount | 59058 |
| Total Medical Medicare Allowed Amount | 52232.89 |
| Total Medical Medicare Payment Amount | 31265.49 |
| Total Medical Medicare Standardized Payment Amount | 34257.84 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 204 |
| Number Of Beneficiaries Age 75 to 84 | 156 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 288 |
| Number Of Male Beneficiaries | 218 |
| 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 | 379 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 127 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 2 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9642 |