| National Provider Identifier [NPI]: | 1346277399 |
| Last Name Of The Provider | THIEDE |
| First Name Of The Provider | STEPHAN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1255 HILYARD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | EUGENE |
| Zip Code Of The Provider | 97401 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 167 |
| Number Of Services | 14351 |
| Number Of Medicare Beneficiaries | 3209 |
| Total Submitted Charge Amount | 1295808.83 |
| Total Medicare Allowed Amount | 280449.04 |
| Total Medicare Payment Amount | 212235.48 |
| Total Medicare Standardized Payment Amount | 222949.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 8987 |
| Number Of Medicare Beneficiaries With Drug Services | 211 |
| Total Drug Submitted ChargeAmount | 39204.96 |
| Total Drug Medicare AllowedAmount | 5814.09 |
| Total Drug Medicare PaymentAmount | 4446.82 |
| Total Drug Medicare Standardized Payment Amount | 4446.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 161 |
| Number Of Medical Services | 5364 |
| Number Of Medicare Beneficiaries With Medical Services | 3208 |
| Total Medical Submitted Charge Amount | 1256603.87 |
| Total Medical Medicare Allowed Amount | 274634.95 |
| Total Medical Medicare Payment Amount | 207788.66 |
| Total Medical Medicare Standardized Payment Amount | 218502.42 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 636 |
| Number Of Beneficiaries Age 65 to 74 | 1222 |
| Number Of Beneficiaries Age 75 to 84 | 858 |
| Number Of Beneficiaries Age Greater 84 | 493 |
| Number Of Female Beneficiaries | 1775 |
| Number Of Male Beneficiaries | 1434 |
| Number Of Non Hispanic White Beneficiaries | 3020 |
| Number Of Black or African American Beneficiaries | 26 |
| Number Of AsianPacific Islander Beneficiaries | 24 |
| Number Of Hispanic Beneficiaries | 54 |
| Number Of American Indian Alaska Native Beneficiaries | 45 |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2370 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 839 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.4687 |