| National Provider Identifier [NPI]: | 1730154170 |
| Last Name Of The Provider | TJAUW |
| First Name Of The Provider | IWAN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3330 NW 56TH ST |
| Street Address 2 Of The Provider | SUITE 206 |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 731124479 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 162 |
| Number Of Services | 10532 |
| Number Of Medicare Beneficiaries | 3250 |
| Total Submitted Charge Amount | 342341.79 |
| Total Medicare Allowed Amount | 314543.69 |
| Total Medicare Payment Amount | 239425.98 |
| Total Medicare Standardized Payment Amount | 261487.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 5865 |
| Number Of Medicare Beneficiaries With Drug Services | 169 |
| Total Drug Submitted ChargeAmount | 5576.7 |
| Total Drug Medicare AllowedAmount | 4402.8 |
| Total Drug Medicare PaymentAmount | 3372.33 |
| Total Drug Medicare Standardized Payment Amount | 3372.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 160 |
| Number Of Medical Services | 4667 |
| Number Of Medicare Beneficiaries With Medical Services | 3250 |
| Total Medical Submitted Charge Amount | 336765.09 |
| Total Medical Medicare Allowed Amount | 310140.89 |
| Total Medical Medicare Payment Amount | 236053.65 |
| Total Medical Medicare Standardized Payment Amount | 258115.53 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 641 |
| Number Of Beneficiaries Age 65 to 74 | 1239 |
| Number Of Beneficiaries Age 75 to 84 | 972 |
| Number Of Beneficiaries Age Greater 84 | 398 |
| Number Of Female Beneficiaries | 1857 |
| Number Of Male Beneficiaries | 1393 |
| Number Of Non Hispanic White Beneficiaries | 2678 |
| Number Of Black or African American Beneficiaries | 267 |
| Number Of AsianPacific Islander Beneficiaries | 39 |
| Number Of Hispanic Beneficiaries | 89 |
| Number Of American Indian Alaska Native Beneficiaries | 152 |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2526 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 724 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.0407 |