| National Provider Identifier [NPI]: | 1710040076 |
| Last Name Of The Provider | KOENIG |
| First Name Of The Provider | DIANNE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2435 NE CUMULUS AVE STE A |
| Street Address 2 Of The Provider | |
| City Of The Provider | MCMINNVILLE |
| Zip Code Of The Provider | 971288862 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 1302 |
| Number Of Medicare Beneficiaries | 60 |
| Total Submitted Charge Amount | 57127 |
| Total Medicare Allowed Amount | 22403.73 |
| Total Medicare Payment Amount | 17479.75 |
| Total Medicare Standardized Payment Amount | 20560.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 33 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 666 |
| Total Drug Medicare AllowedAmount | 360.97 |
| Total Drug Medicare PaymentAmount | 328.19 |
| Total Drug Medicare Standardized Payment Amount | 328.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 4 |
| Number Of Medical Services | 1269 |
| Number Of Medicare Beneficiaries With Medical Services | 60 |
| Total Medical Submitted Charge Amount | 56461 |
| Total Medical Medicare Allowed Amount | 22042.76 |
| Total Medical Medicare Payment Amount | 17151.56 |
| Total Medical Medicare Standardized Payment Amount | 20232.33 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 21 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 25 |
| Number Of Male Beneficiaries | 35 |
| 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 | 67 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.8123 |