| National Provider Identifier [NPI]: | 1952335028 |
| Last Name Of The Provider | VIEDER |
| First Name Of The Provider | SANFORD |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 28050 GRAND RIVER AVENUE |
| Street Address 2 Of The Provider | ER DEPARTMENT |
| City Of The Provider | FARMINGTON HILLS |
| Zip Code Of The Provider | 48336 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 150 |
| Number Of Services | 3151 |
| Number Of Medicare Beneficiaries | 1033 |
| Total Submitted Charge Amount | 509549 |
| Total Medicare Allowed Amount | 194925.41 |
| Total Medicare Payment Amount | 139052.13 |
| Total Medicare Standardized Payment Amount | 135043.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 20 |
| Number Of Drug Services | 492 |
| Number Of Medicare Beneficiaries With Drug Services | 180 |
| Total Drug Submitted ChargeAmount | 7503 |
| Total Drug Medicare AllowedAmount | 666.11 |
| Total Drug Medicare PaymentAmount | 571.87 |
| Total Drug Medicare Standardized Payment Amount | 571.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 130 |
| Number Of Medical Services | 2659 |
| Number Of Medicare Beneficiaries With Medical Services | 1033 |
| Total Medical Submitted Charge Amount | 502046 |
| Total Medical Medicare Allowed Amount | 194259.3 |
| Total Medical Medicare Payment Amount | 138480.26 |
| Total Medical Medicare Standardized Payment Amount | 134471.74 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 176 |
| Number Of Beneficiaries Age 65 to 74 | 383 |
| Number Of Beneficiaries Age 75 to 84 | 299 |
| Number Of Beneficiaries Age Greater 84 | 175 |
| Number Of Female Beneficiaries | 686 |
| Number Of Male Beneficiaries | 347 |
| Number Of Non Hispanic White Beneficiaries | 837 |
| Number Of Black or African American Beneficiaries | 164 |
| 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 | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 852 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 181 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5094 |