| National Provider Identifier [NPI]: | 1639150881 |
| Last Name Of The Provider | LIDMAN |
| First Name Of The Provider | ROGER |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 816 GREENBRIER CIR |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | CHESAPEAKE |
| Zip Code Of The Provider | 233202642 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 82323 |
| Number Of Medicare Beneficiaries | 635 |
| Total Submitted Charge Amount | 2252418.5 |
| Total Medicare Allowed Amount | 1323842.11 |
| Total Medicare Payment Amount | 1003803.49 |
| Total Medicare Standardized Payment Amount | 1009431.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 22 |
| Number Of Drug Services | 78375 |
| Number Of Medicare Beneficiaries With Drug Services | 351 |
| Total Drug Submitted ChargeAmount | 1666480.5 |
| Total Drug Medicare AllowedAmount | 1017814.47 |
| Total Drug Medicare PaymentAmount | 779949.09 |
| Total Drug Medicare Standardized Payment Amount | 779949.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 3948 |
| Number Of Medicare Beneficiaries With Medical Services | 635 |
| Total Medical Submitted Charge Amount | 585938 |
| Total Medical Medicare Allowed Amount | 306027.64 |
| Total Medical Medicare Payment Amount | 223854.4 |
| Total Medical Medicare Standardized Payment Amount | 229482.33 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 86 |
| Number Of Beneficiaries Age 65 to 74 | 278 |
| Number Of Beneficiaries Age 75 to 84 | 197 |
| Number Of Beneficiaries Age Greater 84 | 74 |
| Number Of Female Beneficiaries | 465 |
| Number Of Male Beneficiaries | 170 |
| Number Of Non Hispanic White Beneficiaries | 478 |
| Number Of Black or African American Beneficiaries | 125 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| 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 | 582 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 53 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 42 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.4002 |