| National Provider Identifier [NPI]: | 1164460697 |
| Last Name Of The Provider | DIAZ |
| First Name Of The Provider | MARIO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2020 CAPITOL ST NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALEM |
| Zip Code Of The Provider | 973033244 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 132 |
| Number Of Services | 1793 |
| Number Of Medicare Beneficiaries | 340 |
| Total Submitted Charge Amount | 136970.5 |
| Total Medicare Allowed Amount | 50361.39 |
| Total Medicare Payment Amount | 38059.83 |
| Total Medicare Standardized Payment Amount | 44242.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 64 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 1166 |
| Total Drug Medicare AllowedAmount | 525.02 |
| Total Drug Medicare PaymentAmount | 484.82 |
| Total Drug Medicare Standardized Payment Amount | 484.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 119 |
| Number Of Medical Services | 1729 |
| Number Of Medicare Beneficiaries With Medical Services | 340 |
| Total Medical Submitted Charge Amount | 135804.5 |
| Total Medical Medicare Allowed Amount | 49836.37 |
| Total Medical Medicare Payment Amount | 37575.01 |
| Total Medical Medicare Standardized Payment Amount | 43758.03 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 118 |
| Number Of Beneficiaries Age 75 to 84 | 115 |
| Number Of Beneficiaries Age Greater 84 | 66 |
| Number Of Female Beneficiaries | 190 |
| Number Of Male Beneficiaries | 150 |
| Number Of Non Hispanic White Beneficiaries | 308 |
| 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 | 274 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 66 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2422 |