| National Provider Identifier [NPI]: | 1992768618 |
| Last Name Of The Provider | HENNE |
| First Name Of The Provider | MANFRED |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 20700 BOND RD NE |
| Street Address 2 Of The Provider | BLDG B |
| City Of The Provider | POULSBO |
| Zip Code Of The Provider | 983709099 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 242 |
| Number Of Services | 33205 |
| Number Of Medicare Beneficiaries | 2792 |
| Total Submitted Charge Amount | 2159171 |
| Total Medicare Allowed Amount | 729921.06 |
| Total Medicare Payment Amount | 569073.55 |
| Total Medicare Standardized Payment Amount | 573616.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 25632 |
| Number Of Medicare Beneficiaries With Drug Services | 452 |
| Total Drug Submitted ChargeAmount | 82128 |
| Total Drug Medicare AllowedAmount | 16489.22 |
| Total Drug Medicare PaymentAmount | 12455.35 |
| Total Drug Medicare Standardized Payment Amount | 12455.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 228 |
| Number Of Medical Services | 7573 |
| Number Of Medicare Beneficiaries With Medical Services | 2792 |
| Total Medical Submitted Charge Amount | 2077043 |
| Total Medical Medicare Allowed Amount | 713431.84 |
| Total Medical Medicare Payment Amount | 556618.2 |
| Total Medical Medicare Standardized Payment Amount | 561161.02 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 312 |
| Number Of Beneficiaries Age 65 to 74 | 1534 |
| Number Of Beneficiaries Age 75 to 84 | 685 |
| Number Of Beneficiaries Age Greater 84 | 261 |
| Number Of Female Beneficiaries | 2009 |
| Number Of Male Beneficiaries | 783 |
| Number Of Non Hispanic White Beneficiaries | 2571 |
| Number Of Black or African American Beneficiaries | 17 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | 78 |
| Number Of Beneficiaries With Race Not Else where Classified | 50 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2489 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 303 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8653 |