| National Provider Identifier [NPI]: | 1588759468 |
| Last Name Of The Provider | JENSEN |
| First Name Of The Provider | TAHIRIH |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 480 OSBORNE RD NE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | FRIDLEY |
| Zip Code Of The Provider | 554322773 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 108 |
| Number Of Services | 958 |
| Number Of Medicare Beneficiaries | 143 |
| Total Submitted Charge Amount | 80293 |
| Total Medicare Allowed Amount | 30150.15 |
| Total Medicare Payment Amount | 24058.88 |
| Total Medicare Standardized Payment Amount | 24462.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 69 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 2369 |
| Total Drug Medicare AllowedAmount | 1553.26 |
| Total Drug Medicare PaymentAmount | 1419.28 |
| Total Drug Medicare Standardized Payment Amount | 1419.28 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 94 |
| Number Of Medical Services | 889 |
| Number Of Medicare Beneficiaries With Medical Services | 143 |
| Total Medical Submitted Charge Amount | 77924 |
| Total Medical Medicare Allowed Amount | 28596.89 |
| Total Medical Medicare Payment Amount | 22639.6 |
| Total Medical Medicare Standardized Payment Amount | 23043.7 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 55 |
| Number Of Beneficiaries Age 75 to 84 | 48 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 108 |
| Number Of Male Beneficiaries | 35 |
| Number Of Non Hispanic White Beneficiaries | 129 |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 115 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.151 |