| National Provider Identifier [NPI]: | 1104860782 |
| Last Name Of The Provider | THOMAS |
| First Name Of The Provider | GRACE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2001 CLAFLIN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MANHATTAN |
| Zip Code Of The Provider | 665023415 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 1112 |
| Number Of Medicare Beneficiaries | 218 |
| Total Submitted Charge Amount | 208625 |
| Total Medicare Allowed Amount | 102994.45 |
| Total Medicare Payment Amount | 75869.24 |
| Total Medicare Standardized Payment Amount | 84171.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 1112 |
| Number Of Medicare Beneficiaries With Medical Services | 218 |
| Total Medical Submitted Charge Amount | 208625 |
| Total Medical Medicare Allowed Amount | 102994.45 |
| Total Medical Medicare Payment Amount | 75869.24 |
| Total Medical Medicare Standardized Payment Amount | 84171.14 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 44 |
| Number Of Beneficiaries Age 75 to 84 | 39 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 123 |
| Number Of Male Beneficiaries | 95 |
| Number Of Non Hispanic White Beneficiaries | 196 |
| 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 | 80 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 138 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 62 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 72 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7401 |