| National Provider Identifier [NPI]: | 1164555769 |
| Last Name Of The Provider | KOENCK |
| First Name Of The Provider | LEON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 W 34TH AVE # 539 |
| Street Address 2 Of The Provider | |
| City Of The Provider | ANCHORAGE |
| Zip Code Of The Provider | 995033969 |
| State Code Of The Provider | AK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 257 |
| Number Of Medicare Beneficiaries | 55 |
| Total Submitted Charge Amount | 25866.5 |
| Total Medicare Allowed Amount | 8476.34 |
| Total Medicare Payment Amount | 6512.12 |
| Total Medicare Standardized Payment Amount | 6145.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 108 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 663.5 |
| Total Drug Medicare AllowedAmount | 56.46 |
| Total Drug Medicare PaymentAmount | 44.31 |
| Total Drug Medicare Standardized Payment Amount | 44.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 149 |
| Number Of Medicare Beneficiaries With Medical Services | 55 |
| Total Medical Submitted Charge Amount | 25203 |
| Total Medical Medicare Allowed Amount | 8419.88 |
| Total Medical Medicare Payment Amount | 6467.81 |
| Total Medical Medicare Standardized Payment Amount | 6101.34 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 41 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 28 |
| Number Of Male Beneficiaries | 27 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 55 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 0 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.6353 |