| National Provider Identifier [NPI]: | 1437101508 |
| Last Name Of The Provider | THEISZ |
| First Name Of The Provider | GORDON |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 104A E BROAD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | FALLS CHURCH |
| Zip Code Of The Provider | 220464501 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 412 |
| Number Of Medicare Beneficiaries | 82 |
| Total Submitted Charge Amount | 37625 |
| Total Medicare Allowed Amount | 25717.13 |
| Total Medicare Payment Amount | 18372.66 |
| Total Medicare Standardized Payment Amount | 16579.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 37 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 2115 |
| Total Drug Medicare AllowedAmount | 1660.41 |
| Total Drug Medicare PaymentAmount | 1627.11 |
| Total Drug Medicare Standardized Payment Amount | 1627.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 375 |
| Number Of Medicare Beneficiaries With Medical Services | 82 |
| Total Medical Submitted Charge Amount | 35510 |
| Total Medical Medicare Allowed Amount | 24056.72 |
| Total Medical Medicare Payment Amount | 16745.55 |
| Total Medical Medicare Standardized Payment Amount | 14951.93 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 47 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 40 |
| Number Of Male Beneficiaries | 42 |
| Number Of Non Hispanic White Beneficiaries | 70 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9826 |