| National Provider Identifier [NPI]: | 1316957582 |
| Last Name Of The Provider | DIETZ |
| First Name Of The Provider | MARYETTA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | CRNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1600 W 38TH ST |
| Street Address 2 Of The Provider | SUITE 308 |
| City Of The Provider | AUSTIN |
| Zip Code Of The Provider | 787316400 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 506 |
| Number Of Medicare Beneficiaries | 310 |
| Total Submitted Charge Amount | 143791 |
| Total Medicare Allowed Amount | 41512.5 |
| Total Medicare Payment Amount | 29459.72 |
| Total Medicare Standardized Payment Amount | 35722.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 506 |
| Number Of Medicare Beneficiaries With Medical Services | 310 |
| Total Medical Submitted Charge Amount | 143791 |
| Total Medical Medicare Allowed Amount | 41512.5 |
| Total Medical Medicare Payment Amount | 29459.72 |
| Total Medical Medicare Standardized Payment Amount | 35722.73 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 78 |
| Number Of Beneficiaries Age 75 to 84 | 115 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 177 |
| Number Of Male Beneficiaries | 133 |
| Number Of Non Hispanic White Beneficiaries | 252 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 249 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 62 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 52 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 44 |
| Average HCC Risk Score Of Beneficiaries | 1.8891 |