| National Provider Identifier [NPI]: | 1417974403 |
| Last Name Of The Provider | MAGNE |
| First Name Of The Provider | THERESA |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14155 N 83RD AVE |
| Street Address 2 Of The Provider | SUITE @110 |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 853815639 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 11071 |
| Number Of Medicare Beneficiaries | 1805 |
| Total Submitted Charge Amount | 968972 |
| Total Medicare Allowed Amount | 570474.21 |
| Total Medicare Payment Amount | 404615.41 |
| Total Medicare Standardized Payment Amount | 405681.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 268 |
| Number Of Medicare Beneficiaries With Drug Services | 113 |
| Total Drug Submitted ChargeAmount | 10905 |
| Total Drug Medicare AllowedAmount | 9526.54 |
| Total Drug Medicare PaymentAmount | 7281.47 |
| Total Drug Medicare Standardized Payment Amount | 7281.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 10803 |
| Number Of Medicare Beneficiaries With Medical Services | 1805 |
| Total Medical Submitted Charge Amount | 958067 |
| Total Medical Medicare Allowed Amount | 560947.67 |
| Total Medical Medicare Payment Amount | 397333.94 |
| Total Medical Medicare Standardized Payment Amount | 398400.29 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 1107 |
| Number Of Beneficiaries Age 75 to 84 | 503 |
| Number Of Beneficiaries Age Greater 84 | 142 |
| Number Of Female Beneficiaries | 1021 |
| Number Of Male Beneficiaries | 784 |
| Number Of Non Hispanic White Beneficiaries | 1707 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1787 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.89 |