| National Provider Identifier [NPI]: | 1114353802 |
| Last Name Of The Provider | TIEDY |
| First Name Of The Provider | KATHRYN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.S., CCC-A |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 438 MAIN ST |
| Street Address 2 Of The Provider | SUITE 204 |
| City Of The Provider | MIDDLETOWN |
| Zip Code Of The Provider | 064573396 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Audiologist (billing independently) |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 6 |
| Number Of Services | 1306 |
| Number Of Medicare Beneficiaries | 676 |
| Total Submitted Charge Amount | 76398 |
| Total Medicare Allowed Amount | 33276.43 |
| Total Medicare Payment Amount | 25217.9 |
| Total Medicare Standardized Payment Amount | 23386.09 |
| 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 | 6 |
| Number Of Medical Services | 1306 |
| Number Of Medicare Beneficiaries With Medical Services | 676 |
| Total Medical Submitted Charge Amount | 76398 |
| Total Medical Medicare Allowed Amount | 33276.43 |
| Total Medical Medicare Payment Amount | 25217.9 |
| Total Medical Medicare Standardized Payment Amount | 23386.09 |
| Average Age Of Beneficiaries | 84 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 76 |
| Number Of Beneficiaries Age 75 to 84 | 166 |
| Number Of Beneficiaries Age Greater 84 | 388 |
| Number Of Female Beneficiaries | 500 |
| Number Of Male Beneficiaries | 176 |
| Number Of Non Hispanic White Beneficiaries | 567 |
| Number Of Black or African American Beneficiaries | 65 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 35 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 641 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 64 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 22 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.2313 |