| National Provider Identifier [NPI]: | 1508895673 |
| Last Name Of The Provider | TANDETNIK |
| First Name Of The Provider | ALLA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1180 BEACON ST FL 8 |
| Street Address 2 Of The Provider | |
| City Of The Provider | BROOKLINE |
| Zip Code Of The Provider | 024463885 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 1782 |
| Number Of Medicare Beneficiaries | 292 |
| Total Submitted Charge Amount | 272576.14 |
| Total Medicare Allowed Amount | 122375.89 |
| Total Medicare Payment Amount | 90403.5 |
| Total Medicare Standardized Payment Amount | 89066.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 165 |
| Number Of Medicare Beneficiaries With Drug Services | 129 |
| Total Drug Submitted ChargeAmount | 10545.14 |
| Total Drug Medicare AllowedAmount | 6130.72 |
| Total Drug Medicare PaymentAmount | 5716.14 |
| Total Drug Medicare Standardized Payment Amount | 5716.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 1617 |
| Number Of Medicare Beneficiaries With Medical Services | 292 |
| Total Medical Submitted Charge Amount | 262031 |
| Total Medical Medicare Allowed Amount | 116245.17 |
| Total Medical Medicare Payment Amount | 84687.36 |
| Total Medical Medicare Standardized Payment Amount | 83350 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 119 |
| Number Of Beneficiaries Age 75 to 84 | 108 |
| Number Of Beneficiaries Age Greater 84 | 50 |
| Number Of Female Beneficiaries | 226 |
| Number Of Male Beneficiaries | 66 |
| Number Of Non Hispanic White Beneficiaries | 263 |
| 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 | 177 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 115 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0514 |