| National Provider Identifier [NPI]: | 1962463091 |
| Last Name Of The Provider | TEDDER |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3003 APACHE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | JONESBORO |
| Zip Code Of The Provider | 724017432 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 8223 |
| Number Of Medicare Beneficiaries | 642 |
| Total Submitted Charge Amount | 314385.29 |
| Total Medicare Allowed Amount | 193131.12 |
| Total Medicare Payment Amount | 125938.94 |
| Total Medicare Standardized Payment Amount | 140787.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 3332 |
| Number Of Medicare Beneficiaries With Drug Services | 380 |
| Total Drug Submitted ChargeAmount | 34933.29 |
| Total Drug Medicare AllowedAmount | 2647.12 |
| Total Drug Medicare PaymentAmount | 2138.46 |
| Total Drug Medicare Standardized Payment Amount | 2138.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 4891 |
| Number Of Medicare Beneficiaries With Medical Services | 642 |
| Total Medical Submitted Charge Amount | 279452 |
| Total Medical Medicare Allowed Amount | 190484 |
| Total Medical Medicare Payment Amount | 123800.48 |
| Total Medical Medicare Standardized Payment Amount | 138649.21 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 111 |
| Number Of Beneficiaries Age 65 to 74 | 325 |
| Number Of Beneficiaries Age 75 to 84 | 154 |
| Number Of Beneficiaries Age Greater 84 | 52 |
| Number Of Female Beneficiaries | 382 |
| Number Of Male Beneficiaries | 260 |
| Number Of Non Hispanic White Beneficiaries | 614 |
| 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 | 522 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 120 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9328 |