| National Provider Identifier [NPI]: | 1932251873 |
| Last Name Of The Provider | TAKEGAMI |
| First Name Of The Provider | KEN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 WILLIAM NORTHERN BLVD |
| Street Address 2 Of The Provider | SUITE C |
| City Of The Provider | TULLAHOMA |
| Zip Code Of The Provider | 37388 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 10353 |
| Number Of Medicare Beneficiaries | 1330 |
| Total Submitted Charge Amount | 761458.69 |
| Total Medicare Allowed Amount | 632639.98 |
| Total Medicare Payment Amount | 463101.18 |
| Total Medicare Standardized Payment Amount | 486441.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 137 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 1550 |
| Total Drug Medicare AllowedAmount | 243.38 |
| Total Drug Medicare PaymentAmount | 187.78 |
| Total Drug Medicare Standardized Payment Amount | 187.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 10216 |
| Number Of Medicare Beneficiaries With Medical Services | 1330 |
| Total Medical Submitted Charge Amount | 759908.69 |
| Total Medical Medicare Allowed Amount | 632396.6 |
| Total Medical Medicare Payment Amount | 462913.4 |
| Total Medical Medicare Standardized Payment Amount | 486253.28 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 534 |
| Number Of Beneficiaries Age 75 to 84 | 567 |
| Number Of Beneficiaries Age Greater 84 | 186 |
| Number Of Female Beneficiaries | 652 |
| Number Of Male Beneficiaries | 678 |
| Number Of Non Hispanic White Beneficiaries | 1309 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1296 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9675 |