| National Provider Identifier [NPI]: | 1730120163 |
| Last Name Of The Provider | RIDDER |
| First Name Of The Provider | BRENT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 23961 CALLE DE LA MAGDALENA |
| Street Address 2 Of The Provider | #115 |
| City Of The Provider | LAGUNA HILLS |
| Zip Code Of The Provider | 926533616 |
| 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 | 40 |
| Number Of Services | 1759 |
| Number Of Medicare Beneficiaries | 793 |
| Total Submitted Charge Amount | 182310 |
| Total Medicare Allowed Amount | 164427.81 |
| Total Medicare Payment Amount | 115807.22 |
| Total Medicare Standardized Payment Amount | 104065.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 74 |
| Number Of Medicare Beneficiaries With Drug Services | 63 |
| Total Drug Submitted ChargeAmount | 1865 |
| Total Drug Medicare AllowedAmount | 880.32 |
| Total Drug Medicare PaymentAmount | 842.42 |
| Total Drug Medicare Standardized Payment Amount | 842.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 1685 |
| Number Of Medicare Beneficiaries With Medical Services | 793 |
| Total Medical Submitted Charge Amount | 180445 |
| Total Medical Medicare Allowed Amount | 163547.49 |
| Total Medical Medicare Payment Amount | 114964.8 |
| Total Medical Medicare Standardized Payment Amount | 103223.5 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 200 |
| Number Of Beneficiaries Age 75 to 84 | 250 |
| Number Of Beneficiaries Age Greater 84 | 309 |
| Number Of Female Beneficiaries | 547 |
| Number Of Male Beneficiaries | 246 |
| Number Of Non Hispanic White Beneficiaries | 719 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 33 |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 751 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2924 |