| National Provider Identifier [NPI]: | 1215007315 |
| Last Name Of The Provider | PUCKETT |
| First Name Of The Provider | TEDD |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 106 S FRANKLIN ST STE C |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHRISTIANSBURG |
| Zip Code Of The Provider | 240733547 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 7495 |
| Number Of Medicare Beneficiaries | 1238 |
| Total Submitted Charge Amount | 1872237.6 |
| Total Medicare Allowed Amount | 1000424.8 |
| Total Medicare Payment Amount | 759384.6 |
| Total Medicare Standardized Payment Amount | 769569.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 1538 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 317155 |
| Total Drug Medicare AllowedAmount | 308111.29 |
| Total Drug Medicare PaymentAmount | 241356.03 |
| Total Drug Medicare Standardized Payment Amount | 241356.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 87 |
| Number Of Medical Services | 5957 |
| Number Of Medicare Beneficiaries With Medical Services | 1238 |
| Total Medical Submitted Charge Amount | 1555082.6 |
| Total Medical Medicare Allowed Amount | 692313.51 |
| Total Medical Medicare Payment Amount | 518028.57 |
| Total Medical Medicare Standardized Payment Amount | 528213.84 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 66 |
| Number Of Beneficiaries Age 65 to 74 | 483 |
| Number Of Beneficiaries Age 75 to 84 | 494 |
| Number Of Beneficiaries Age Greater 84 | 195 |
| Number Of Female Beneficiaries | 758 |
| Number Of Male Beneficiaries | 480 |
| Number Of Non Hispanic White Beneficiaries | 1193 |
| Number Of Black or African American Beneficiaries | 24 |
| 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 | 1112 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 126 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0985 |