| National Provider Identifier [NPI]: | 1326264763 |
| Last Name Of The Provider | TIEDE |
| First Name Of The Provider | MATTHEW |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 MONROE AVE NW |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495031455 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 300 |
| Number Of Services | 3846 |
| Number Of Medicare Beneficiaries | 1992 |
| Total Submitted Charge Amount | 597997 |
| Total Medicare Allowed Amount | 189092.34 |
| Total Medicare Payment Amount | 145928.84 |
| Total Medicare Standardized Payment Amount | 150533.01 |
| 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 | 300 |
| Number Of Medical Services | 3846 |
| Number Of Medicare Beneficiaries With Medical Services | 1992 |
| Total Medical Submitted Charge Amount | 597997 |
| Total Medical Medicare Allowed Amount | 189092.34 |
| Total Medical Medicare Payment Amount | 145928.84 |
| Total Medical Medicare Standardized Payment Amount | 150533.01 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 726 |
| Number Of Beneficiaries Age 65 to 74 | 572 |
| Number Of Beneficiaries Age 75 to 84 | 428 |
| Number Of Beneficiaries Age Greater 84 | 266 |
| Number Of Female Beneficiaries | 1106 |
| Number Of Male Beneficiaries | 886 |
| Number Of Non Hispanic White Beneficiaries | 1512 |
| Number Of Black or African American Beneficiaries | 329 |
| Number Of AsianPacific Islander Beneficiaries | 25 |
| Number Of Hispanic Beneficiaries | 97 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1163 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 829 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.3142 |