| National Provider Identifier [NPI]: | 1073695292 |
| Last Name Of The Provider | TIDMORE |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2418 N OAK ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | VALDOSTA |
| Zip Code Of The Provider | 316022576 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 146 |
| Number Of Services | 282763 |
| Number Of Medicare Beneficiaries | 1781 |
| Total Submitted Charge Amount | 8938969 |
| Total Medicare Allowed Amount | 3590986.68 |
| Total Medicare Payment Amount | 2730872.22 |
| Total Medicare Standardized Payment Amount | 2774224.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 27 |
| Number Of Drug Services | 259306 |
| Number Of Medicare Beneficiaries With Drug Services | 903 |
| Total Drug Submitted ChargeAmount | 6164889 |
| Total Drug Medicare AllowedAmount | 2830734.17 |
| Total Drug Medicare PaymentAmount | 2156200.02 |
| Total Drug Medicare Standardized Payment Amount | 2156200.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 119 |
| Number Of Medical Services | 23457 |
| Number Of Medicare Beneficiaries With Medical Services | 1781 |
| Total Medical Submitted Charge Amount | 2774080 |
| Total Medical Medicare Allowed Amount | 760252.51 |
| Total Medical Medicare Payment Amount | 574672.2 |
| Total Medical Medicare Standardized Payment Amount | 618024.35 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 328 |
| Number Of Beneficiaries Age 65 to 74 | 796 |
| Number Of Beneficiaries Age 75 to 84 | 517 |
| Number Of Beneficiaries Age Greater 84 | 140 |
| Number Of Female Beneficiaries | 1365 |
| Number Of Male Beneficiaries | 416 |
| Number Of Non Hispanic White Beneficiaries | 1406 |
| Number Of Black or African American Beneficiaries | 348 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1434 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 347 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 31 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2206 |