| National Provider Identifier [NPI]: | 1609190404 |
| Last Name Of The Provider | WIEDERHOLD |
| First Name Of The Provider | BENJAMIN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1411 E 31ST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | OAKLAND |
| Zip Code Of The Provider | 946021018 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 1730 |
| Number Of Medicare Beneficiaries | 911 |
| Total Submitted Charge Amount | 1044571 |
| Total Medicare Allowed Amount | 181877.69 |
| Total Medicare Payment Amount | 141278.92 |
| Total Medicare Standardized Payment Amount | 139521.32 |
| 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 | 40 |
| Number Of Medical Services | 1730 |
| Number Of Medicare Beneficiaries With Medical Services | 911 |
| Total Medical Submitted Charge Amount | 1044571 |
| Total Medical Medicare Allowed Amount | 181877.69 |
| Total Medical Medicare Payment Amount | 141278.92 |
| Total Medical Medicare Standardized Payment Amount | 139521.32 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 284 |
| Number Of Beneficiaries Age 65 to 74 | 260 |
| Number Of Beneficiaries Age 75 to 84 | 199 |
| Number Of Beneficiaries Age Greater 84 | 168 |
| Number Of Female Beneficiaries | 497 |
| Number Of Male Beneficiaries | 414 |
| Number Of Non Hispanic White Beneficiaries | 447 |
| Number Of Black or African American Beneficiaries | 123 |
| Number Of AsianPacific Islander Beneficiaries | 109 |
| Number Of Hispanic Beneficiaries | 213 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 379 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 532 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.1702 |