| National Provider Identifier [NPI]: | 1528059060 |
| Last Name Of The Provider | DIETRICH |
| First Name Of The Provider | LARRY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M. D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1305 LAKELAND HILLS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKELAND |
| Zip Code Of The Provider | 338054542 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 245 |
| Number Of Services | 4508 |
| Number Of Medicare Beneficiaries | 2120 |
| Total Submitted Charge Amount | 587664.6 |
| Total Medicare Allowed Amount | 152595.84 |
| Total Medicare Payment Amount | 116008.77 |
| Total Medicare Standardized Payment Amount | 115976.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1270 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 3200 |
| Total Drug Medicare AllowedAmount | 292.66 |
| Total Drug Medicare PaymentAmount | 229.44 |
| Total Drug Medicare Standardized Payment Amount | 229.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 243 |
| Number Of Medical Services | 3238 |
| Number Of Medicare Beneficiaries With Medical Services | 2120 |
| Total Medical Submitted Charge Amount | 584464.6 |
| Total Medical Medicare Allowed Amount | 152303.18 |
| Total Medical Medicare Payment Amount | 115779.33 |
| Total Medical Medicare Standardized Payment Amount | 115746.79 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 390 |
| Number Of Beneficiaries Age 65 to 74 | 670 |
| Number Of Beneficiaries Age 75 to 84 | 676 |
| Number Of Beneficiaries Age Greater 84 | 384 |
| Number Of Female Beneficiaries | 1206 |
| Number Of Male Beneficiaries | 914 |
| Number Of Non Hispanic White Beneficiaries | 1808 |
| Number Of Black or African American Beneficiaries | 189 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 91 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1496 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 624 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 41 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.2234 |