| National Provider Identifier [NPI]: | 1497966808 |
| Last Name Of The Provider | RIDDELL |
| First Name Of The Provider | CARL |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D., F.A.C.O.G. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5800 W 10TH ST |
| Street Address 2 Of The Provider | STE.401 |
| City Of The Provider | LITTLE ROCK |
| Zip Code Of The Provider | 722041752 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Obstetrics/Gynecology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 7570 |
| Number Of Medicare Beneficiaries | 65 |
| Total Submitted Charge Amount | 4279.18 |
| Total Medicare Allowed Amount | 3308.36 |
| Total Medicare Payment Amount | 2551.15 |
| Total Medicare Standardized Payment Amount | 2556.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 7500 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 2475 |
| Total Drug Medicare AllowedAmount | 1905.15 |
| Total Drug Medicare PaymentAmount | 1328.24 |
| Total Drug Medicare Standardized Payment Amount | 1328.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 70 |
| Number Of Medicare Beneficiaries With Medical Services | 34 |
| Total Medical Submitted Charge Amount | 1804.18 |
| Total Medical Medicare Allowed Amount | 1403.21 |
| Total Medical Medicare Payment Amount | 1222.91 |
| Total Medical Medicare Standardized Payment Amount | 1228.14 |
| Average Age Of Beneficiaries | 36 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | 36 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 0 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | |
| Percent Of With Hypertension | 26 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6955 |