| National Provider Identifier [NPI]: | 1588899215 |
| Last Name Of The Provider | DIEHL |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1721 S STEPHENSON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | IRON MOUNTAIN |
| Zip Code Of The Provider | 498013637 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 178 |
| Number Of Services | 2646 |
| Number Of Medicare Beneficiaries | 1339 |
| Total Submitted Charge Amount | 355632 |
| Total Medicare Allowed Amount | 85046.66 |
| Total Medicare Payment Amount | 66144.3 |
| Total Medicare Standardized Payment Amount | 68085.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 178 |
| Number Of Medical Services | 2646 |
| Number Of Medicare Beneficiaries With Medical Services | 1339 |
| Total Medical Submitted Charge Amount | 355632 |
| Total Medical Medicare Allowed Amount | 85046.66 |
| Total Medical Medicare Payment Amount | 66144.3 |
| Total Medical Medicare Standardized Payment Amount | 68085.59 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 240 |
| Number Of Beneficiaries Age 65 to 74 | 498 |
| Number Of Beneficiaries Age 75 to 84 | 371 |
| Number Of Beneficiaries Age Greater 84 | 230 |
| Number Of Female Beneficiaries | 843 |
| Number Of Male Beneficiaries | 496 |
| Number Of Non Hispanic White Beneficiaries | 1322 |
| 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 | 1040 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 299 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1744 |