| National Provider Identifier [NPI]: | 1760489447 |
| Last Name Of The Provider | DIEDERICH |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2508 BANKSVILLE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PITTSBURGH |
| Zip Code Of The Provider | 152162802 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 287 |
| Number Of Medicare Beneficiaries | 35 |
| Total Submitted Charge Amount | 19010 |
| Total Medicare Allowed Amount | 14992.26 |
| Total Medicare Payment Amount | 11121.49 |
| Total Medicare Standardized Payment Amount | 11577.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 31 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 2195 |
| Total Drug Medicare AllowedAmount | 1591.54 |
| Total Drug Medicare PaymentAmount | 1559.11 |
| Total Drug Medicare Standardized Payment Amount | 1559.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 256 |
| Number Of Medicare Beneficiaries With Medical Services | 35 |
| Total Medical Submitted Charge Amount | 16815 |
| Total Medical Medicare Allowed Amount | 13400.72 |
| Total Medical Medicare Payment Amount | 9562.38 |
| Total Medical Medicare Standardized Payment Amount | 10018.16 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 18 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 18 |
| Number Of Male Beneficiaries | 17 |
| 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 | 35 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 0 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 0 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 0 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 0 |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7177 |