| National Provider Identifier [NPI]: | 1528045408 |
| Last Name Of The Provider | TIEDE |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 250 CENTRAL AVE N |
| Street Address 2 Of The Provider | STE 220 |
| City Of The Provider | WAYZATA |
| Zip Code Of The Provider | 553911206 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 3226 |
| Number Of Medicare Beneficiaries | 470 |
| Total Submitted Charge Amount | 225586.01 |
| Total Medicare Allowed Amount | 100430.54 |
| Total Medicare Payment Amount | 74924.42 |
| Total Medicare Standardized Payment Amount | 76099.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 362 |
| Number Of Medicare Beneficiaries With Drug Services | 131 |
| Total Drug Submitted ChargeAmount | 20287 |
| Total Drug Medicare AllowedAmount | 12377.81 |
| Total Drug Medicare PaymentAmount | 11971.94 |
| Total Drug Medicare Standardized Payment Amount | 11971.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 2864 |
| Number Of Medicare Beneficiaries With Medical Services | 470 |
| Total Medical Submitted Charge Amount | 205299.01 |
| Total Medical Medicare Allowed Amount | 88052.73 |
| Total Medical Medicare Payment Amount | 62952.48 |
| Total Medical Medicare Standardized Payment Amount | 64128.02 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 161 |
| Number Of Beneficiaries Age 75 to 84 | 144 |
| Number Of Beneficiaries Age Greater 84 | 118 |
| Number Of Female Beneficiaries | 212 |
| Number Of Male Beneficiaries | 258 |
| Number Of Non Hispanic White Beneficiaries | 442 |
| 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 | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 423 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1369 |