National Provider Identifier [NPI]: |
1124023098 |
Last Name Of The Provider |
DIAMOND |
First Name Of The Provider |
CHAD |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
110 MILLSAPS DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
HATTIESBURG |
Zip Code Of The Provider |
394021347 |
State Code Of The Provider |
MS |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
87 |
Number Of Services |
5428 |
Number Of Medicare Beneficiaries |
561 |
Total Submitted Charge Amount |
291544.8 |
Total Medicare Allowed Amount |
151193.29 |
Total Medicare Payment Amount |
109342.55 |
Total Medicare Standardized Payment Amount |
119229.11 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
11 |
Number Of Drug Services |
410 |
Number Of Medicare Beneficiaries With Drug Services |
142 |
Total Drug Submitted ChargeAmount |
7412.8 |
Total Drug Medicare AllowedAmount |
4946.99 |
Total Drug Medicare PaymentAmount |
4156.29 |
Total Drug Medicare Standardized Payment Amount |
4156.29 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
76 |
Number Of Medical Services |
5018 |
Number Of Medicare Beneficiaries With Medical Services |
561 |
Total Medical Submitted Charge Amount |
284132 |
Total Medical Medicare Allowed Amount |
146246.3 |
Total Medical Medicare Payment Amount |
105186.26 |
Total Medical Medicare Standardized Payment Amount |
115072.82 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
104 |
Number Of Beneficiaries Age 65 to 74 |
264 |
Number Of Beneficiaries Age 75 to 84 |
141 |
Number Of Beneficiaries Age Greater 84 |
52 |
Number Of Female Beneficiaries |
336 |
Number Of Male Beneficiaries |
225 |
Number Of Non Hispanic White Beneficiaries |
457 |
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 |
436 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
125 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
12 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
38 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
0.9087 |