| National Provider Identifier [NPI]: | 1982846135 |
| Last Name Of The Provider | TAN |
| First Name Of The Provider | CYNTHIA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2160 S 1ST AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MAYWOOD |
| Zip Code Of The Provider | 601533328 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 85 |
| Number Of Services | 3148 |
| Number Of Medicare Beneficiaries | 615 |
| Total Submitted Charge Amount | 262954.24 |
| Total Medicare Allowed Amount | 96603.88 |
| Total Medicare Payment Amount | 80438.99 |
| Total Medicare Standardized Payment Amount | 67904.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 2127 |
| Number Of Medicare Beneficiaries With Drug Services | 32 |
| Total Drug Submitted ChargeAmount | 46800 |
| Total Drug Medicare AllowedAmount | 541.12 |
| Total Drug Medicare PaymentAmount | 405.67 |
| Total Drug Medicare Standardized Payment Amount | 405.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 1021 |
| Number Of Medicare Beneficiaries With Medical Services | 615 |
| Total Medical Submitted Charge Amount | 216154.24 |
| Total Medical Medicare Allowed Amount | 96062.76 |
| Total Medical Medicare Payment Amount | 80033.32 |
| Total Medical Medicare Standardized Payment Amount | 67499.14 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 112 |
| Number Of Beneficiaries Age 65 to 74 | 274 |
| Number Of Beneficiaries Age 75 to 84 | 167 |
| Number Of Beneficiaries Age Greater 84 | 62 |
| Number Of Female Beneficiaries | 443 |
| Number Of Male Beneficiaries | 172 |
| Number Of Non Hispanic White Beneficiaries | 377 |
| Number Of Black or African American Beneficiaries | 83 |
| Number Of AsianPacific Islander Beneficiaries | 59 |
| Number Of Hispanic Beneficiaries | 76 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 457 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 158 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2339 |