| National Provider Identifier [NPI]: | 1023014297 |
| Last Name Of The Provider | THOEN |
| First Name Of The Provider | DENNIS |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1151 EAST 3900 SOUTH |
| Street Address 2 Of The Provider | # B150 |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841241216 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 28125 |
| Number Of Medicare Beneficiaries | 51 |
| Total Submitted Charge Amount | 506547 |
| Total Medicare Allowed Amount | 414486.7 |
| Total Medicare Payment Amount | 316586.07 |
| Total Medicare Standardized Payment Amount | 317473.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 27965 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 466018 |
| Total Drug Medicare AllowedAmount | 401000.48 |
| Total Drug Medicare PaymentAmount | 307692.56 |
| Total Drug Medicare Standardized Payment Amount | 307692.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 11 |
| Number Of Medical Services | 160 |
| Number Of Medicare Beneficiaries With Medical Services | 51 |
| Total Medical Submitted Charge Amount | 40529 |
| Total Medical Medicare Allowed Amount | 13486.22 |
| Total Medical Medicare Payment Amount | 8893.51 |
| Total Medical Medicare Standardized Payment Amount | 9781.27 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 37 |
| Number Of Male Beneficiaries | 14 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 0 |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 27 |
| Percent Of With Hypertension | 41 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0171 |