| National Provider Identifier [NPI]: | 1659562650 |
| Last Name Of The Provider | THIELE |
| First Name Of The Provider | JENS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3629 VISTA WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | OCEANSIDE |
| Zip Code Of The Provider | 920564522 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 92 |
| Number Of Services | 10013 |
| Number Of Medicare Beneficiaries | 942 |
| Total Submitted Charge Amount | 1651634 |
| Total Medicare Allowed Amount | 1028613.39 |
| Total Medicare Payment Amount | 773014.84 |
| Total Medicare Standardized Payment Amount | 712809.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 209 |
| Number Of Medicare Beneficiaries With Drug Services | 153 |
| Total Drug Submitted ChargeAmount | 22560 |
| Total Drug Medicare AllowedAmount | 19564.31 |
| Total Drug Medicare PaymentAmount | 15184.5 |
| Total Drug Medicare Standardized Payment Amount | 15184.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 90 |
| Number Of Medical Services | 9804 |
| Number Of Medicare Beneficiaries With Medical Services | 941 |
| Total Medical Submitted Charge Amount | 1629074 |
| Total Medical Medicare Allowed Amount | 1009049.08 |
| Total Medical Medicare Payment Amount | 757830.34 |
| Total Medical Medicare Standardized Payment Amount | 697624.51 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 438 |
| Number Of Beneficiaries Age 75 to 84 | 331 |
| Number Of Beneficiaries Age Greater 84 | 133 |
| Number Of Female Beneficiaries | 454 |
| Number Of Male Beneficiaries | 488 |
| Number Of Non Hispanic White Beneficiaries | 890 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 911 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9818 |