| National Provider Identifier [NPI]: | 1366440687 |
| Last Name Of The Provider | TATUM |
| First Name Of The Provider | CLIFTON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 E GRAY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 402022012 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 188 |
| Number Of Services | 3547 |
| Number Of Medicare Beneficiaries | 2074 |
| Total Submitted Charge Amount | 431240.92 |
| Total Medicare Allowed Amount | 154774.49 |
| Total Medicare Payment Amount | 116792.21 |
| Total Medicare Standardized Payment Amount | 124832.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 188 |
| Number Of Medical Services | 3547 |
| Number Of Medicare Beneficiaries With Medical Services | 2074 |
| Total Medical Submitted Charge Amount | 431240.92 |
| Total Medical Medicare Allowed Amount | 154774.49 |
| Total Medical Medicare Payment Amount | 116792.21 |
| Total Medical Medicare Standardized Payment Amount | 124832.49 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 567 |
| Number Of Beneficiaries Age 65 to 74 | 754 |
| Number Of Beneficiaries Age 75 to 84 | 497 |
| Number Of Beneficiaries Age Greater 84 | 256 |
| Number Of Female Beneficiaries | 1217 |
| Number Of Male Beneficiaries | 857 |
| Number Of Non Hispanic White Beneficiaries | 1616 |
| Number Of Black or African American Beneficiaries | 406 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1394 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 680 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.2203 |