| National Provider Identifier [NPI]: | 1639115165 |
| Last Name Of The Provider | THELEN |
| First Name Of The Provider | MARIA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | P.A.-C. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1055 S US 27 |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT JOHNS |
| Zip Code Of The Provider | 488792437 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 107 |
| Number Of Services | 1651 |
| Number Of Medicare Beneficiaries | 254 |
| Total Submitted Charge Amount | 107761.5 |
| Total Medicare Allowed Amount | 66871.03 |
| Total Medicare Payment Amount | 48833.48 |
| Total Medicare Standardized Payment Amount | 60120.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 52 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 1694 |
| Total Drug Medicare AllowedAmount | 1360.91 |
| Total Drug Medicare PaymentAmount | 1303.94 |
| Total Drug Medicare Standardized Payment Amount | 1303.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 99 |
| Number Of Medical Services | 1599 |
| Number Of Medicare Beneficiaries With Medical Services | 254 |
| Total Medical Submitted Charge Amount | 106067.5 |
| Total Medical Medicare Allowed Amount | 65510.12 |
| Total Medical Medicare Payment Amount | 47529.54 |
| Total Medical Medicare Standardized Payment Amount | 58816.39 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 58 |
| Number Of Beneficiaries Age 65 to 74 | 112 |
| Number Of Beneficiaries Age 75 to 84 | 52 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 172 |
| Number Of Male Beneficiaries | 82 |
| 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 | 201 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 53 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9022 |