| National Provider Identifier [NPI]: | 1053341669 |
| Last Name Of The Provider | DIETRICH |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 546 E PINE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | STOCKTON |
| Zip Code Of The Provider | 952045525 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 158 |
| Number Of Services | 27476 |
| Number Of Medicare Beneficiaries | 2669 |
| Total Submitted Charge Amount | 1996806.57 |
| Total Medicare Allowed Amount | 594942.94 |
| Total Medicare Payment Amount | 464879.65 |
| Total Medicare Standardized Payment Amount | 444480.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 23323 |
| Number Of Medicare Beneficiaries With Drug Services | 388 |
| Total Drug Submitted ChargeAmount | 92483.45 |
| Total Drug Medicare AllowedAmount | 7743.61 |
| Total Drug Medicare PaymentAmount | 6013.07 |
| Total Drug Medicare Standardized Payment Amount | 6013.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 155 |
| Number Of Medical Services | 4153 |
| Number Of Medicare Beneficiaries With Medical Services | 2669 |
| Total Medical Submitted Charge Amount | 1904323.12 |
| Total Medical Medicare Allowed Amount | 587199.33 |
| Total Medical Medicare Payment Amount | 458866.58 |
| Total Medical Medicare Standardized Payment Amount | 438467.74 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 417 |
| Number Of Beneficiaries Age 65 to 74 | 1239 |
| Number Of Beneficiaries Age 75 to 84 | 753 |
| Number Of Beneficiaries Age Greater 84 | 260 |
| Number Of Female Beneficiaries | 1640 |
| Number Of Male Beneficiaries | 1029 |
| Number Of Non Hispanic White Beneficiaries | 1894 |
| Number Of Black or African American Beneficiaries | 141 |
| Number Of AsianPacific Islander Beneficiaries | 130 |
| Number Of Hispanic Beneficiaries | 451 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1969 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 700 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0762 |