National Provider Identifier [NPI]: |
1598781262 |
Last Name Of The Provider |
TANGE |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1881 HIGHWAY XX |
Street Address 2 Of The Provider |
|
City Of The Provider |
MOSINEE |
Zip Code Of The Provider |
54455 |
State Code Of The Provider |
WI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
100 |
Number Of Services |
3564 |
Number Of Medicare Beneficiaries |
457 |
Total Submitted Charge Amount |
326259 |
Total Medicare Allowed Amount |
101260.2 |
Total Medicare Payment Amount |
78348.71 |
Total Medicare Standardized Payment Amount |
81350.61 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
120 |
Number Of Medicare Beneficiaries With Drug Services |
82 |
Total Drug Submitted ChargeAmount |
3409 |
Total Drug Medicare AllowedAmount |
3177.02 |
Total Drug Medicare PaymentAmount |
3095.43 |
Total Drug Medicare Standardized Payment Amount |
3095.43 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
92 |
Number Of Medical Services |
3444 |
Number Of Medicare Beneficiaries With Medical Services |
457 |
Total Medical Submitted Charge Amount |
322850 |
Total Medical Medicare Allowed Amount |
98083.18 |
Total Medical Medicare Payment Amount |
75253.28 |
Total Medical Medicare Standardized Payment Amount |
78255.18 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
37 |
Number Of Beneficiaries Age 65 to 74 |
236 |
Number Of Beneficiaries Age 75 to 84 |
134 |
Number Of Beneficiaries Age Greater 84 |
50 |
Number Of Female Beneficiaries |
231 |
Number Of Male Beneficiaries |
226 |
Number Of Non Hispanic White Beneficiaries |
440 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
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 |
363 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
94 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
21 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
49 |
Percent Of With Hypertension |
57 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.3154 |