| National Provider Identifier [NPI]: | 1366523292 |
| Last Name Of The Provider | DIAL |
| First Name Of The Provider | JONATHAN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1900 TEBEAU ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WAYCROSS |
| Zip Code Of The Provider | 315016357 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 226 |
| Number Of Medicare Beneficiaries | 46 |
| Total Submitted Charge Amount | 125896 |
| Total Medicare Allowed Amount | 7381.73 |
| Total Medicare Payment Amount | 5805 |
| Total Medicare Standardized Payment Amount | 6381.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 146 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 5256 |
| Total Drug Medicare AllowedAmount | 1738.66 |
| Total Drug Medicare PaymentAmount | 1363.12 |
| Total Drug Medicare Standardized Payment Amount | 1363.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 80 |
| Number Of Medicare Beneficiaries With Medical Services | 46 |
| Total Medical Submitted Charge Amount | 120640 |
| Total Medical Medicare Allowed Amount | 5643.07 |
| Total Medical Medicare Payment Amount | 4441.88 |
| Total Medical Medicare Standardized Payment Amount | 5017.92 |
| 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 | 15 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 34 |
| Number Of Male Beneficiaries | 12 |
| 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 | 26 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.552 |