| National Provider Identifier [NPI]: | 1972597912 |
| Last Name Of The Provider | AMIDON |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1101 DECATUR ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SANDUSKY |
| Zip Code Of The Provider | 448703335 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 1294 |
| Number Of Medicare Beneficiaries | 749 |
| Total Submitted Charge Amount | 550331 |
| Total Medicare Allowed Amount | 129585.5 |
| Total Medicare Payment Amount | 98691.33 |
| Total Medicare Standardized Payment Amount | 99915.58 |
| 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 | 65 |
| Number Of Medical Services | 1294 |
| Number Of Medicare Beneficiaries With Medical Services | 749 |
| Total Medical Submitted Charge Amount | 550331 |
| Total Medical Medicare Allowed Amount | 129585.5 |
| Total Medical Medicare Payment Amount | 98691.33 |
| Total Medical Medicare Standardized Payment Amount | 99915.58 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 225 |
| Number Of Beneficiaries Age 65 to 74 | 207 |
| Number Of Beneficiaries Age 75 to 84 | 203 |
| Number Of Beneficiaries Age Greater 84 | 114 |
| Number Of Female Beneficiaries | 432 |
| Number Of Male Beneficiaries | 317 |
| Number Of Non Hispanic White Beneficiaries | 624 |
| Number Of Black or African American Beneficiaries | 103 |
| 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 | 485 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 264 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.8388 |