| National Provider Identifier [NPI]: | 1932361177 |
| Last Name Of The Provider | MAW |
| First Name Of The Provider | THIN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4921 PARKVIEW PL |
| Street Address 2 Of The Provider | 5TH FLOOR SUITE C |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631101032 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 970 |
| Number Of Medicare Beneficiaries | 326 |
| Total Submitted Charge Amount | 570509 |
| Total Medicare Allowed Amount | 100721.23 |
| Total Medicare Payment Amount | 79000.61 |
| Total Medicare Standardized Payment Amount | 75921.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 46 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 8512 |
| Total Drug Medicare AllowedAmount | 4286.79 |
| Total Drug Medicare PaymentAmount | 4200.99 |
| Total Drug Medicare Standardized Payment Amount | 4200.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 924 |
| Number Of Medicare Beneficiaries With Medical Services | 322 |
| Total Medical Submitted Charge Amount | 561997 |
| Total Medical Medicare Allowed Amount | 96434.44 |
| Total Medical Medicare Payment Amount | 74799.62 |
| Total Medical Medicare Standardized Payment Amount | 71720.76 |
| Average Age Of Beneficiaries | 56 |
| Number Of Beneficiaries Age Less65 | 215 |
| Number Of Beneficiaries Age 65 to 74 | 93 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 131 |
| Number Of Male Beneficiaries | 195 |
| Number Of Non Hispanic White Beneficiaries | 163 |
| Number Of Black or African American Beneficiaries | 63 |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | 63 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 179 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 147 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 60 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 20 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 4.8684 |