| National Provider Identifier [NPI]: | 1306839949 |
| Last Name Of The Provider | TIEDE |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 SIXTH AVE N |
| Street Address 2 Of The Provider | CENTRACARE CLINIC |
| City Of The Provider | ST CLOUD |
| Zip Code Of The Provider | 563032735 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 83 |
| Number Of Services | 1501 |
| Number Of Medicare Beneficiaries | 847 |
| Total Submitted Charge Amount | 405403.55 |
| Total Medicare Allowed Amount | 140372.27 |
| Total Medicare Payment Amount | 105979.19 |
| Total Medicare Standardized Payment Amount | 112527.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 83 |
| Number Of Medical Services | 1501 |
| Number Of Medicare Beneficiaries With Medical Services | 847 |
| Total Medical Submitted Charge Amount | 405403.55 |
| Total Medical Medicare Allowed Amount | 140372.27 |
| Total Medical Medicare Payment Amount | 105979.19 |
| Total Medical Medicare Standardized Payment Amount | 112527.62 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 146 |
| Number Of Beneficiaries Age 65 to 74 | 236 |
| Number Of Beneficiaries Age 75 to 84 | 292 |
| Number Of Beneficiaries Age Greater 84 | 173 |
| Number Of Female Beneficiaries | 425 |
| Number Of Male Beneficiaries | 422 |
| Number Of Non Hispanic White Beneficiaries | 821 |
| Number Of Black or African American Beneficiaries | |
| 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 | 678 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 169 |
| Percent Of With Atrial Fibrillation | 30 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5225 |