| National Provider Identifier [NPI]: | 1093711186 |
| Last Name Of The Provider | TEDDER |
| First Name Of The Provider | STEPHEN |
| 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 | 6001 PROFESSIONAL PKWY |
| Street Address 2 Of The Provider | SUITE 2040 |
| City Of The Provider | DOUGLASVILLE |
| Zip Code Of The Provider | 301345632 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 2098 |
| Number Of Medicare Beneficiaries | 743 |
| Total Submitted Charge Amount | 313985 |
| Total Medicare Allowed Amount | 190799.05 |
| Total Medicare Payment Amount | 129402.46 |
| Total Medicare Standardized Payment Amount | 132365.85 |
| 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 | 24 |
| Number Of Medical Services | 2098 |
| Number Of Medicare Beneficiaries With Medical Services | 743 |
| Total Medical Submitted Charge Amount | 313985 |
| Total Medical Medicare Allowed Amount | 190799.05 |
| Total Medical Medicare Payment Amount | 129402.46 |
| Total Medical Medicare Standardized Payment Amount | 132365.85 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 89 |
| Number Of Beneficiaries Age 65 to 74 | 397 |
| Number Of Beneficiaries Age 75 to 84 | 192 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 467 |
| Number Of Male Beneficiaries | 276 |
| Number Of Non Hispanic White Beneficiaries | 608 |
| Number Of Black or African American Beneficiaries | 112 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 668 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0413 |