| National Provider Identifier [NPI]: | 1003038746 |
| Last Name Of The Provider | TAVES |
| First Name Of The Provider | ADAM |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3050 MONTVALE DR STE A |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627046924 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 155 |
| Number Of Services | 5718 |
| Number Of Medicare Beneficiaries | 3609 |
| Total Submitted Charge Amount | 1169195.76 |
| Total Medicare Allowed Amount | 200987.8 |
| Total Medicare Payment Amount | 156407.16 |
| Total Medicare Standardized Payment Amount | 158639.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 467 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 2290.02 |
| Total Drug Medicare AllowedAmount | 429.42 |
| Total Drug Medicare PaymentAmount | 336.68 |
| Total Drug Medicare Standardized Payment Amount | 336.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 152 |
| Number Of Medical Services | 5251 |
| Number Of Medicare Beneficiaries With Medical Services | 3609 |
| Total Medical Submitted Charge Amount | 1166905.74 |
| Total Medical Medicare Allowed Amount | 200558.38 |
| Total Medical Medicare Payment Amount | 156070.48 |
| Total Medical Medicare Standardized Payment Amount | 158303.07 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 790 |
| Number Of Beneficiaries Age 65 to 74 | 1229 |
| Number Of Beneficiaries Age 75 to 84 | 968 |
| Number Of Beneficiaries Age Greater 84 | 622 |
| Number Of Female Beneficiaries | 2146 |
| Number Of Male Beneficiaries | 1463 |
| Number Of Non Hispanic White Beneficiaries | 2921 |
| Number Of Black or African American Beneficiaries | 628 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2474 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1135 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7993 |