| National Provider Identifier [NPI]: | 1508025412 |
| Last Name Of The Provider | TANTUCO |
| First Name Of The Provider | IRVIN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1213 HERMANN DRIVE |
| Street Address 2 Of The Provider | SUITE 570 |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770047025 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 3650 |
| Number Of Medicare Beneficiaries | 484 |
| Total Submitted Charge Amount | 347164.06 |
| Total Medicare Allowed Amount | 328638.45 |
| Total Medicare Payment Amount | 249626.07 |
| Total Medicare Standardized Payment Amount | 251293.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 63 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 517.46 |
| Total Drug Medicare AllowedAmount | 439.02 |
| Total Drug Medicare PaymentAmount | 413.73 |
| Total Drug Medicare Standardized Payment Amount | 413.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 3587 |
| Number Of Medicare Beneficiaries With Medical Services | 484 |
| Total Medical Submitted Charge Amount | 346646.6 |
| Total Medical Medicare Allowed Amount | 328199.43 |
| Total Medical Medicare Payment Amount | 249212.34 |
| Total Medical Medicare Standardized Payment Amount | 250879.59 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 113 |
| Number Of Beneficiaries Age 65 to 74 | 175 |
| Number Of Beneficiaries Age 75 to 84 | 127 |
| Number Of Beneficiaries Age Greater 84 | 69 |
| Number Of Female Beneficiaries | 267 |
| Number Of Male Beneficiaries | 217 |
| Number Of Non Hispanic White Beneficiaries | 220 |
| Number Of Black or African American Beneficiaries | 200 |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 336 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 148 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 55 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.7334 |