| National Provider Identifier [NPI]: | 1285629667 |
| Last Name Of The Provider | HANSEN |
| First Name Of The Provider | THOMAS |
| 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 | 5950 UNIVERSITY AVE |
| Street Address 2 Of The Provider | STE 280 |
| City Of The Provider | WEST DES MOINES |
| Zip Code Of The Provider | 502668216 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 9770 |
| Number Of Medicare Beneficiaries | 908 |
| Total Submitted Charge Amount | 1519335 |
| Total Medicare Allowed Amount | 358307.67 |
| Total Medicare Payment Amount | 270400.08 |
| Total Medicare Standardized Payment Amount | 268081.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 5879 |
| Number Of Medicare Beneficiaries With Drug Services | 618 |
| Total Drug Submitted ChargeAmount | 51808 |
| Total Drug Medicare AllowedAmount | 11800.48 |
| Total Drug Medicare PaymentAmount | 9135.02 |
| Total Drug Medicare Standardized Payment Amount | 9135.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 3891 |
| Number Of Medicare Beneficiaries With Medical Services | 908 |
| Total Medical Submitted Charge Amount | 1467527 |
| Total Medical Medicare Allowed Amount | 346507.19 |
| Total Medical Medicare Payment Amount | 261265.06 |
| Total Medical Medicare Standardized Payment Amount | 258946.54 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 199 |
| Number Of Beneficiaries Age 65 to 74 | 402 |
| Number Of Beneficiaries Age 75 to 84 | 237 |
| Number Of Beneficiaries Age Greater 84 | 70 |
| Number Of Female Beneficiaries | 579 |
| Number Of Male Beneficiaries | 329 |
| Number Of Non Hispanic White Beneficiaries | 863 |
| Number Of Black or African American Beneficiaries | 24 |
| 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 | 761 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 147 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 62 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0277 |