| National Provider Identifier [NPI]: | 1124002654 |
| Last Name Of The Provider | TAN |
| First Name Of The Provider | DJERRICK |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 W BROWN DEER RD |
| Street Address 2 Of The Provider | SUITE 202 |
| City Of The Provider | BAYSIDE |
| Zip Code Of The Provider | 532171618 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 147 |
| Number Of Services | 8088 |
| Number Of Medicare Beneficiaries | 2237 |
| Total Submitted Charge Amount | 860162.53 |
| Total Medicare Allowed Amount | 140702.13 |
| Total Medicare Payment Amount | 105431.7 |
| Total Medicare Standardized Payment Amount | 110823.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 4326 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 16244.71 |
| Total Drug Medicare AllowedAmount | 875.36 |
| Total Drug Medicare PaymentAmount | 613.83 |
| Total Drug Medicare Standardized Payment Amount | 613.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 145 |
| Number Of Medical Services | 3762 |
| Number Of Medicare Beneficiaries With Medical Services | 2237 |
| Total Medical Submitted Charge Amount | 843917.82 |
| Total Medical Medicare Allowed Amount | 139826.77 |
| Total Medical Medicare Payment Amount | 104817.87 |
| Total Medical Medicare Standardized Payment Amount | 110209.49 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 296 |
| Number Of Beneficiaries Age 65 to 74 | 755 |
| Number Of Beneficiaries Age 75 to 84 | 688 |
| Number Of Beneficiaries Age Greater 84 | 498 |
| Number Of Female Beneficiaries | 1312 |
| Number Of Male Beneficiaries | 925 |
| Number Of Non Hispanic White Beneficiaries | 1995 |
| Number Of Black or African American Beneficiaries | 170 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1816 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 421 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6541 |