| National Provider Identifier [NPI]: | 1588733125 |
| Last Name Of The Provider | TIEDEMAN |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 17 N MEDICAL PARK DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | FISHERSVILLE |
| Zip Code Of The Provider | 229392344 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 22659 |
| Number Of Medicare Beneficiaries | 1185 |
| Total Submitted Charge Amount | 7107636.5 |
| Total Medicare Allowed Amount | 6325633.09 |
| Total Medicare Payment Amount | 4893144.35 |
| Total Medicare Standardized Payment Amount | 4919754.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 9504 |
| Number Of Medicare Beneficiaries With Drug Services | 511 |
| Total Drug Submitted ChargeAmount | 5550261.5 |
| Total Drug Medicare AllowedAmount | 5051646.21 |
| Total Drug Medicare PaymentAmount | 3933813.19 |
| Total Drug Medicare Standardized Payment Amount | 3933813.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 13155 |
| Number Of Medicare Beneficiaries With Medical Services | 1185 |
| Total Medical Submitted Charge Amount | 1557375 |
| Total Medical Medicare Allowed Amount | 1273986.88 |
| Total Medical Medicare Payment Amount | 959331.16 |
| Total Medical Medicare Standardized Payment Amount | 985941.72 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 79 |
| Number Of Beneficiaries Age 65 to 74 | 381 |
| Number Of Beneficiaries Age 75 to 84 | 439 |
| Number Of Beneficiaries Age Greater 84 | 286 |
| Number Of Female Beneficiaries | 696 |
| Number Of Male Beneficiaries | 489 |
| Number Of Non Hispanic White Beneficiaries | 1112 |
| Number Of Black or African American Beneficiaries | 49 |
| 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 | 1054 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 131 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4169 |