| National Provider Identifier [NPI]: | 1902885262 |
| Last Name Of The Provider | RAUCKMAN |
| First Name Of The Provider | DIANA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1460 W VALENCIA RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TUCSON |
| Zip Code Of The Provider | 857466001 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 305 |
| Number Of Medicare Beneficiaries | 60 |
| Total Submitted Charge Amount | 27466.01 |
| Total Medicare Allowed Amount | 19209.94 |
| Total Medicare Payment Amount | 14309.51 |
| Total Medicare Standardized Payment Amount | 17102.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 35 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1257 |
| Total Drug Medicare AllowedAmount | 609.66 |
| Total Drug Medicare PaymentAmount | 592.77 |
| Total Drug Medicare Standardized Payment Amount | 592.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 270 |
| Number Of Medicare Beneficiaries With Medical Services | 60 |
| Total Medical Submitted Charge Amount | 26209.01 |
| Total Medical Medicare Allowed Amount | 18600.28 |
| Total Medical Medicare Payment Amount | 13716.74 |
| Total Medical Medicare Standardized Payment Amount | 16509.65 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 28 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 43 |
| Number Of Male Beneficiaries | 17 |
| Number Of Non Hispanic White Beneficiaries | 33 |
| 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 | 34 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 26 |
| 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 | |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0662 |