| National Provider Identifier [NPI]: | 1336212810 |
| Last Name Of The Provider | TAI |
| First Name Of The Provider | ANGELA |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 166 4TH ST E |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT PAUL |
| Zip Code Of The Provider | 551011421 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 175 |
| Number Of Services | 7263 |
| Number Of Medicare Beneficiaries | 2862 |
| Total Submitted Charge Amount | 449590.19 |
| Total Medicare Allowed Amount | 150978.07 |
| Total Medicare Payment Amount | 118620.02 |
| Total Medicare Standardized Payment Amount | 122262.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 2496 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 4711 |
| Total Drug Medicare AllowedAmount | 1211.23 |
| Total Drug Medicare PaymentAmount | 949.6 |
| Total Drug Medicare Standardized Payment Amount | 949.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 171 |
| Number Of Medical Services | 4767 |
| Number Of Medicare Beneficiaries With Medical Services | 2861 |
| Total Medical Submitted Charge Amount | 444879.19 |
| Total Medical Medicare Allowed Amount | 149766.84 |
| Total Medical Medicare Payment Amount | 117670.42 |
| Total Medical Medicare Standardized Payment Amount | 121312.9 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 684 |
| Number Of Beneficiaries Age 65 to 74 | 999 |
| Number Of Beneficiaries Age 75 to 84 | 759 |
| Number Of Beneficiaries Age Greater 84 | 420 |
| Number Of Female Beneficiaries | 1868 |
| Number Of Male Beneficiaries | 994 |
| Number Of Non Hispanic White Beneficiaries | 2546 |
| Number Of Black or African American Beneficiaries | 154 |
| Number Of AsianPacific Islander Beneficiaries | 44 |
| Number Of Hispanic Beneficiaries | 71 |
| Number Of American Indian Alaska Native Beneficiaries | 12 |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2105 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 757 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4705 |