| National Provider Identifier [NPI]: | 1346221579 |
| Last Name Of The Provider | HEATH |
| First Name Of The Provider | DIANE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10475 CENTURION PKWY N |
| Street Address 2 Of The Provider | SUITE 220 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322565003 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 2547 |
| Number Of Medicare Beneficiaries | 534 |
| Total Submitted Charge Amount | 362395 |
| Total Medicare Allowed Amount | 118098.51 |
| Total Medicare Payment Amount | 84715.44 |
| Total Medicare Standardized Payment Amount | 93712.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 939 |
| Number Of Medicare Beneficiaries With Drug Services | 184 |
| Total Drug Submitted ChargeAmount | 32696 |
| Total Drug Medicare AllowedAmount | 12874.72 |
| Total Drug Medicare PaymentAmount | 9643.98 |
| Total Drug Medicare Standardized Payment Amount | 9643.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 1608 |
| Number Of Medicare Beneficiaries With Medical Services | 534 |
| Total Medical Submitted Charge Amount | 329699 |
| Total Medical Medicare Allowed Amount | 105223.79 |
| Total Medical Medicare Payment Amount | 75071.46 |
| Total Medical Medicare Standardized Payment Amount | 84068.16 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 287 |
| Number Of Beneficiaries Age 75 to 84 | 185 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 346 |
| Number Of Male Beneficiaries | 188 |
| Number Of Non Hispanic White Beneficiaries | 489 |
| Number Of Black or African American Beneficiaries | 24 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 522 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 0.9673 |