| National Provider Identifier [NPI]: | 1265437404 |
| Last Name Of The Provider | VIDIC |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 303 S NAPPANEE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ELKHART |
| Zip Code Of The Provider | 465142066 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 11718 |
| Number Of Medicare Beneficiaries | 860 |
| Total Submitted Charge Amount | 664663 |
| Total Medicare Allowed Amount | 312699.39 |
| Total Medicare Payment Amount | 231935.82 |
| Total Medicare Standardized Payment Amount | 239341.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 8791 |
| Number Of Medicare Beneficiaries With Drug Services | 36 |
| Total Drug Submitted ChargeAmount | 94256 |
| Total Drug Medicare AllowedAmount | 46541.3 |
| Total Drug Medicare PaymentAmount | 35697.19 |
| Total Drug Medicare Standardized Payment Amount | 35697.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 85 |
| Number Of Medical Services | 2927 |
| Number Of Medicare Beneficiaries With Medical Services | 860 |
| Total Medical Submitted Charge Amount | 570407 |
| Total Medical Medicare Allowed Amount | 266158.09 |
| Total Medical Medicare Payment Amount | 196238.63 |
| Total Medical Medicare Standardized Payment Amount | 203644.5 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 185 |
| Number Of Beneficiaries Age 65 to 74 | 267 |
| Number Of Beneficiaries Age 75 to 84 | 252 |
| Number Of Beneficiaries Age Greater 84 | 156 |
| Number Of Female Beneficiaries | 494 |
| Number Of Male Beneficiaries | 366 |
| Number Of Non Hispanic White Beneficiaries | 799 |
| Number Of Black or African American Beneficiaries | 36 |
| 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 | 635 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 225 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 1.4183 |