| National Provider Identifier [NPI]: | 1427056886 |
| Last Name Of The Provider | DIETEMAN |
| First Name Of The Provider | DAVID |
| 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 | 3190 GLENWOOD PARK AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ERIE |
| Zip Code Of The Provider | 165082746 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 3243 |
| Number Of Medicare Beneficiaries | 1045 |
| Total Submitted Charge Amount | 284262 |
| Total Medicare Allowed Amount | 199352.99 |
| Total Medicare Payment Amount | 141552.47 |
| Total Medicare Standardized Payment Amount | 147019.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 144 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 720 |
| Total Drug Medicare AllowedAmount | 254.68 |
| Total Drug Medicare PaymentAmount | 199.8 |
| Total Drug Medicare Standardized Payment Amount | 199.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 3099 |
| Number Of Medicare Beneficiaries With Medical Services | 1045 |
| Total Medical Submitted Charge Amount | 283542 |
| Total Medical Medicare Allowed Amount | 199098.31 |
| Total Medical Medicare Payment Amount | 141352.67 |
| Total Medical Medicare Standardized Payment Amount | 146819.76 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 111 |
| Number Of Beneficiaries Age 65 to 74 | 423 |
| Number Of Beneficiaries Age 75 to 84 | 329 |
| Number Of Beneficiaries Age Greater 84 | 182 |
| Number Of Female Beneficiaries | 551 |
| Number Of Male Beneficiaries | 494 |
| Number Of Non Hispanic White Beneficiaries | 1000 |
| 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 | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 901 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 144 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0301 |