| National Provider Identifier [NPI]: | 1477669992 |
| Last Name Of The Provider | THIEBERG |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4708 ALLIANCE BLVD STE 300 |
| Street Address 2 Of The Provider | BAYLOR MEDICAL PLAZA 1 |
| City Of The Provider | PLANO |
| Zip Code Of The Provider | 750935339 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 69 |
| Number Of Services | 6810 |
| Number Of Medicare Beneficiaries | 1428 |
| Total Submitted Charge Amount | 617764 |
| Total Medicare Allowed Amount | 300259.22 |
| Total Medicare Payment Amount | 208989.2 |
| Total Medicare Standardized Payment Amount | 220637.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 162 |
| Number Of Medicare Beneficiaries With Drug Services | 78 |
| Total Drug Submitted ChargeAmount | 1274 |
| Total Drug Medicare AllowedAmount | 258.01 |
| Total Drug Medicare PaymentAmount | 160.43 |
| Total Drug Medicare Standardized Payment Amount | 160.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 6648 |
| Number Of Medicare Beneficiaries With Medical Services | 1428 |
| Total Medical Submitted Charge Amount | 616490 |
| Total Medical Medicare Allowed Amount | 300001.21 |
| Total Medical Medicare Payment Amount | 208828.77 |
| Total Medical Medicare Standardized Payment Amount | 220477.31 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 738 |
| Number Of Beneficiaries Age 75 to 84 | 501 |
| Number Of Beneficiaries Age Greater 84 | 156 |
| Number Of Female Beneficiaries | 630 |
| Number Of Male Beneficiaries | 798 |
| Number Of Non Hispanic White Beneficiaries | 1358 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1402 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 26 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8865 |