| National Provider Identifier [NPI]: | 1134174618 |
| Last Name Of The Provider | HIETTE |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 77 W. FOREST AVENUE |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | FLAGSTAFF |
| Zip Code Of The Provider | 860011482 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 238 |
| Number Of Services | 7880 |
| Number Of Medicare Beneficiaries | 2059 |
| Total Submitted Charge Amount | 666687.53 |
| Total Medicare Allowed Amount | 155583.81 |
| Total Medicare Payment Amount | 117471.56 |
| Total Medicare Standardized Payment Amount | 120303.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 4602 |
| Number Of Medicare Beneficiaries With Drug Services | 77 |
| Total Drug Submitted ChargeAmount | 4017.45 |
| Total Drug Medicare AllowedAmount | 1237.47 |
| Total Drug Medicare PaymentAmount | 952.02 |
| Total Drug Medicare Standardized Payment Amount | 952.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 231 |
| Number Of Medical Services | 3278 |
| Number Of Medicare Beneficiaries With Medical Services | 2059 |
| Total Medical Submitted Charge Amount | 662670.08 |
| Total Medical Medicare Allowed Amount | 154346.34 |
| Total Medical Medicare Payment Amount | 116519.54 |
| Total Medical Medicare Standardized Payment Amount | 119351.62 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 284 |
| Number Of Beneficiaries Age 65 to 74 | 913 |
| Number Of Beneficiaries Age 75 to 84 | 616 |
| Number Of Beneficiaries Age Greater 84 | 246 |
| Number Of Female Beneficiaries | 1069 |
| Number Of Male Beneficiaries | 990 |
| Number Of Non Hispanic White Beneficiaries | 1402 |
| Number Of Black or African American Beneficiaries | 20 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 134 |
| Number Of American Indian Alaska Native Beneficiaries | 461 |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1486 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 573 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4659 |