| National Provider Identifier [NPI]: | 1134160435 |
| Last Name Of The Provider | DIETZEK |
| First Name Of The Provider | ALAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 67 SAND PIT RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DANBURY |
| Zip Code Of The Provider | 068104032 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Vascular Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 143 |
| Number Of Services | 3174 |
| Number Of Medicare Beneficiaries | 1698 |
| Total Submitted Charge Amount | 2262373.92 |
| Total Medicare Allowed Amount | 352488.97 |
| Total Medicare Payment Amount | 270365.09 |
| Total Medicare Standardized Payment Amount | 253261.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 143 |
| Number Of Medical Services | 3174 |
| Number Of Medicare Beneficiaries With Medical Services | 1698 |
| Total Medical Submitted Charge Amount | 2262373.92 |
| Total Medical Medicare Allowed Amount | 352488.97 |
| Total Medical Medicare Payment Amount | 270365.09 |
| Total Medical Medicare Standardized Payment Amount | 253261.92 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 111 |
| Number Of Beneficiaries Age 65 to 74 | 570 |
| Number Of Beneficiaries Age 75 to 84 | 634 |
| Number Of Beneficiaries Age Greater 84 | 383 |
| Number Of Female Beneficiaries | 902 |
| Number Of Male Beneficiaries | 796 |
| Number Of Non Hispanic White Beneficiaries | 1552 |
| Number Of Black or African American Beneficiaries | 37 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 65 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1325 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 373 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.852 |