| National Provider Identifier [NPI]: | 1528027794 |
| Last Name Of The Provider | WIEDEMER |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 711 LOGAN BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ALTOONA |
| Zip Code Of The Provider | 166024165 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 3804 |
| Number Of Medicare Beneficiaries | 757 |
| Total Submitted Charge Amount | 263042 |
| Total Medicare Allowed Amount | 189743.7 |
| Total Medicare Payment Amount | 133005.99 |
| Total Medicare Standardized Payment Amount | 141442.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 143 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 1716 |
| Total Drug Medicare AllowedAmount | 429.21 |
| Total Drug Medicare PaymentAmount | 285.89 |
| Total Drug Medicare Standardized Payment Amount | 285.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 3661 |
| Number Of Medicare Beneficiaries With Medical Services | 757 |
| Total Medical Submitted Charge Amount | 261326 |
| Total Medical Medicare Allowed Amount | 189314.49 |
| Total Medical Medicare Payment Amount | 132720.1 |
| Total Medical Medicare Standardized Payment Amount | 141156.9 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 158 |
| Number Of Beneficiaries Age 65 to 74 | 236 |
| Number Of Beneficiaries Age 75 to 84 | 209 |
| Number Of Beneficiaries Age Greater 84 | 154 |
| Number Of Female Beneficiaries | 467 |
| Number Of Male Beneficiaries | 290 |
| Number Of Non Hispanic White Beneficiaries | 736 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 527 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 230 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 53 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.551 |