| National Provider Identifier [NPI]: | 1902868490 |
| Last Name Of The Provider | THALER |
| First Name Of The Provider | DIANE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 33 GREEN BAY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | STURGEON BAY |
| Zip Code Of The Provider | 542352831 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 72 |
| Number Of Services | 6612 |
| Number Of Medicare Beneficiaries | 1042 |
| Total Submitted Charge Amount | 1233198.16 |
| Total Medicare Allowed Amount | 359642.71 |
| Total Medicare Payment Amount | 266744.87 |
| Total Medicare Standardized Payment Amount | 273702.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 772 |
| Number Of Medicare Beneficiaries With Drug Services | 119 |
| Total Drug Submitted ChargeAmount | 11433.32 |
| Total Drug Medicare AllowedAmount | 1373.06 |
| Total Drug Medicare PaymentAmount | 1027.38 |
| Total Drug Medicare Standardized Payment Amount | 1027.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 5840 |
| Number Of Medicare Beneficiaries With Medical Services | 1042 |
| Total Medical Submitted Charge Amount | 1221764.84 |
| Total Medical Medicare Allowed Amount | 358269.65 |
| Total Medical Medicare Payment Amount | 265717.49 |
| Total Medical Medicare Standardized Payment Amount | 272674.91 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 516 |
| Number Of Beneficiaries Age 75 to 84 | 334 |
| Number Of Beneficiaries Age Greater 84 | 151 |
| Number Of Female Beneficiaries | 558 |
| Number Of Male Beneficiaries | 484 |
| Number Of Non Hispanic White Beneficiaries | 1015 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 994 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.8082 |