| National Provider Identifier [NPI]: | 1346210077 |
| Last Name Of The Provider | TAN |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 204 ARK RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOUNT LAUREL |
| Zip Code Of The Provider | 080543100 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 153 |
| Number Of Services | 11244 |
| Number Of Medicare Beneficiaries | 1548 |
| Total Submitted Charge Amount | 974654.2 |
| Total Medicare Allowed Amount | 217566.43 |
| Total Medicare Payment Amount | 161296.9 |
| Total Medicare Standardized Payment Amount | 151215.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 9261 |
| Number Of Medicare Beneficiaries With Drug Services | 156 |
| Total Drug Submitted ChargeAmount | 8953.2 |
| Total Drug Medicare AllowedAmount | 3846.18 |
| Total Drug Medicare PaymentAmount | 2961.21 |
| Total Drug Medicare Standardized Payment Amount | 2961.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 149 |
| Number Of Medical Services | 1983 |
| Number Of Medicare Beneficiaries With Medical Services | 1548 |
| Total Medical Submitted Charge Amount | 965701 |
| Total Medical Medicare Allowed Amount | 213720.25 |
| Total Medical Medicare Payment Amount | 158335.69 |
| Total Medical Medicare Standardized Payment Amount | 148254.2 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 239 |
| Number Of Beneficiaries Age 65 to 74 | 519 |
| Number Of Beneficiaries Age 75 to 84 | 507 |
| Number Of Beneficiaries Age Greater 84 | 283 |
| Number Of Female Beneficiaries | 928 |
| Number Of Male Beneficiaries | 620 |
| Number Of Non Hispanic White Beneficiaries | 1120 |
| Number Of Black or African American Beneficiaries | 337 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 51 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1307 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 241 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.6991 |