| National Provider Identifier [NPI]: | 1215960844 |
| Last Name Of The Provider | TANASOVICH |
| First Name Of The Provider | CHERYL |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1300 S ELISEO DR |
| Street Address 2 Of The Provider | SUITE 207 |
| City Of The Provider | GREENBRAE |
| Zip Code Of The Provider | 949042023 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 7290 |
| Number Of Medicare Beneficiaries | 1570 |
| Total Submitted Charge Amount | 791393.28 |
| Total Medicare Allowed Amount | 494795.71 |
| Total Medicare Payment Amount | 362343.02 |
| Total Medicare Standardized Payment Amount | 306736.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 245 |
| Number Of Medicare Beneficiaries With Drug Services | 96 |
| Total Drug Submitted ChargeAmount | 7075 |
| Total Drug Medicare AllowedAmount | 6156.72 |
| Total Drug Medicare PaymentAmount | 4815.99 |
| Total Drug Medicare Standardized Payment Amount | 4815.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 7045 |
| Number Of Medicare Beneficiaries With Medical Services | 1570 |
| Total Medical Submitted Charge Amount | 784318.28 |
| Total Medical Medicare Allowed Amount | 488638.99 |
| Total Medical Medicare Payment Amount | 357527.03 |
| Total Medical Medicare Standardized Payment Amount | 301920.37 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 729 |
| Number Of Beneficiaries Age 75 to 84 | 490 |
| Number Of Beneficiaries Age Greater 84 | 300 |
| Number Of Female Beneficiaries | 968 |
| Number Of Male Beneficiaries | 602 |
| Number Of Non Hispanic White Beneficiaries | 1495 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1523 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 14 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8709 |