| National Provider Identifier [NPI]: | 1518042167 |
| Last Name Of The Provider | PO |
| First Name Of The Provider | TEDMUND |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5549 VAN BUREN BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | RIVERSIDE |
| Zip Code Of The Provider | 925032068 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 255 |
| Number Of Medicare Beneficiaries | 61 |
| Total Submitted Charge Amount | 21326.56 |
| Total Medicare Allowed Amount | 14205.63 |
| Total Medicare Payment Amount | 7857.82 |
| Total Medicare Standardized Payment Amount | 7619.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 27 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 1099.4 |
| Total Drug Medicare AllowedAmount | 324.54 |
| Total Drug Medicare PaymentAmount | 314.88 |
| Total Drug Medicare Standardized Payment Amount | 314.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 228 |
| Number Of Medicare Beneficiaries With Medical Services | 61 |
| Total Medical Submitted Charge Amount | 20227.16 |
| Total Medical Medicare Allowed Amount | 13881.09 |
| Total Medical Medicare Payment Amount | 7542.94 |
| Total Medical Medicare Standardized Payment Amount | 7304.43 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 27 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 33 |
| Number Of Male Beneficiaries | 28 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 43 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| 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 | |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2985 |