| National Provider Identifier [NPI]: | 1215138789 |
| Last Name Of The Provider | TACKETT |
| First Name Of The Provider | ANDREA |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD, FACC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1941 JOHNSON AVE |
| Street Address 2 Of The Provider | STE 101 |
| City Of The Provider | SAN LUIS OBISPO |
| Zip Code Of The Provider | 934014154 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 6274 |
| Number Of Medicare Beneficiaries | 1455 |
| Total Submitted Charge Amount | 1135263 |
| Total Medicare Allowed Amount | 517863.91 |
| Total Medicare Payment Amount | 386077.83 |
| Total Medicare Standardized Payment Amount | 371072.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 379 |
| Number Of Medicare Beneficiaries With Drug Services | 100 |
| Total Drug Submitted ChargeAmount | 51601 |
| Total Drug Medicare AllowedAmount | 19605.96 |
| Total Drug Medicare PaymentAmount | 15370.92 |
| Total Drug Medicare Standardized Payment Amount | 15370.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 76 |
| Number Of Medical Services | 5895 |
| Number Of Medicare Beneficiaries With Medical Services | 1455 |
| Total Medical Submitted Charge Amount | 1083662 |
| Total Medical Medicare Allowed Amount | 498257.95 |
| Total Medical Medicare Payment Amount | 370706.91 |
| Total Medical Medicare Standardized Payment Amount | 355701.47 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 83 |
| Number Of Beneficiaries Age 65 to 74 | 595 |
| Number Of Beneficiaries Age 75 to 84 | 457 |
| Number Of Beneficiaries Age Greater 84 | 320 |
| Number Of Female Beneficiaries | 794 |
| Number Of Male Beneficiaries | 661 |
| Number Of Non Hispanic White Beneficiaries | 1346 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | 61 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1301 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 154 |
| Percent Of With Atrial Fibrillation | 32 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.335 |