| National Provider Identifier [NPI]: | 1134129240 |
| Last Name Of The Provider | DIAZ |
| First Name Of The Provider | GONZALO |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4305 N MESA ST |
| Street Address 2 Of The Provider | STE A |
| City Of The Provider | EL PASO |
| Zip Code Of The Provider | 799021123 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 4611 |
| Number Of Medicare Beneficiaries | 1220 |
| Total Submitted Charge Amount | 1959320 |
| Total Medicare Allowed Amount | 722446.04 |
| Total Medicare Payment Amount | 558487.45 |
| Total Medicare Standardized Payment Amount | 600400.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 908 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 761 |
| Total Drug Medicare AllowedAmount | 368.59 |
| Total Drug Medicare PaymentAmount | 296.89 |
| Total Drug Medicare Standardized Payment Amount | 296.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 3703 |
| Number Of Medicare Beneficiaries With Medical Services | 1220 |
| Total Medical Submitted Charge Amount | 1958559 |
| Total Medical Medicare Allowed Amount | 722077.45 |
| Total Medical Medicare Payment Amount | 558190.56 |
| Total Medical Medicare Standardized Payment Amount | 600103.13 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 338 |
| Number Of Beneficiaries Age 65 to 74 | 504 |
| Number Of Beneficiaries Age 75 to 84 | 295 |
| Number Of Beneficiaries Age Greater 84 | 83 |
| Number Of Female Beneficiaries | 684 |
| Number Of Male Beneficiaries | 536 |
| Number Of Non Hispanic White Beneficiaries | 399 |
| Number Of Black or African American Beneficiaries | 48 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 750 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 746 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 474 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5007 |