| National Provider Identifier [NPI]: | 1689701229 |
| Last Name Of The Provider | KAMENETSKY |
| First Name Of The Provider | DIANNE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10870 BROCKWAY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TRUCKEE |
| Zip Code Of The Provider | 961612054 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 4334 |
| Number Of Medicare Beneficiaries | 727 |
| Total Submitted Charge Amount | 352695 |
| Total Medicare Allowed Amount | 211448.26 |
| Total Medicare Payment Amount | 151321.15 |
| Total Medicare Standardized Payment Amount | 150906.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 46 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 3655 |
| Total Drug Medicare AllowedAmount | 2813.59 |
| Total Drug Medicare PaymentAmount | 2194.62 |
| Total Drug Medicare Standardized Payment Amount | 2194.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 4288 |
| Number Of Medicare Beneficiaries With Medical Services | 727 |
| Total Medical Submitted Charge Amount | 349040 |
| Total Medical Medicare Allowed Amount | 208634.67 |
| Total Medical Medicare Payment Amount | 149126.53 |
| Total Medical Medicare Standardized Payment Amount | 148711.99 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 455 |
| Number Of Beneficiaries Age 75 to 84 | 206 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 370 |
| Number Of Male Beneficiaries | 357 |
| Number Of Non Hispanic White Beneficiaries | 695 |
| 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 | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 698 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 29 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 7 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 4 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 10 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.7316 |