| National Provider Identifier [NPI]: | 1588663686 |
| Last Name Of The Provider | TIDMAN |
| First Name Of The Provider | RAYMOND |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 101 RIVERSTONE VIS |
| Street Address 2 Of The Provider | SUITE 205 |
| City Of The Provider | BLUE RIDGE |
| Zip Code Of The Provider | 305136648 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 236 |
| Number Of Services | 24692 |
| Number Of Medicare Beneficiaries | 1876 |
| Total Submitted Charge Amount | 1198859.32 |
| Total Medicare Allowed Amount | 475649.29 |
| Total Medicare Payment Amount | 357983.14 |
| Total Medicare Standardized Payment Amount | 398557.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 12710 |
| Number Of Medicare Beneficiaries With Drug Services | 231 |
| Total Drug Submitted ChargeAmount | 27163 |
| Total Drug Medicare AllowedAmount | 9712.44 |
| Total Drug Medicare PaymentAmount | 7392.61 |
| Total Drug Medicare Standardized Payment Amount | 7392.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 223 |
| Number Of Medical Services | 11982 |
| Number Of Medicare Beneficiaries With Medical Services | 1876 |
| Total Medical Submitted Charge Amount | 1171696.32 |
| Total Medical Medicare Allowed Amount | 465936.85 |
| Total Medical Medicare Payment Amount | 350590.53 |
| Total Medical Medicare Standardized Payment Amount | 391164.83 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 298 |
| Number Of Beneficiaries Age 65 to 74 | 893 |
| Number Of Beneficiaries Age 75 to 84 | 515 |
| Number Of Beneficiaries Age Greater 84 | 170 |
| Number Of Female Beneficiaries | 1111 |
| Number Of Male Beneficiaries | 765 |
| Number Of Non Hispanic White Beneficiaries | 1832 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1517 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 359 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1193 |