| National Provider Identifier [NPI]: | 1154438968 |
| Last Name Of The Provider | TANNER |
| First Name Of The Provider | JESSICA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2799 W GRAND BLVD |
| Street Address 2 Of The Provider | DEPARTMENT OF DIAGNOSTIC RADIOLOGY |
| City Of The Provider | DETROIT |
| Zip Code Of The Provider | 482022608 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 185 |
| Number Of Services | 5838 |
| Number Of Medicare Beneficiaries | 4079 |
| Total Submitted Charge Amount | 466470 |
| Total Medicare Allowed Amount | 154971.29 |
| Total Medicare Payment Amount | 121769.15 |
| Total Medicare Standardized Payment Amount | 127222.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 185 |
| Number Of Medical Services | 5838 |
| Number Of Medicare Beneficiaries With Medical Services | 4079 |
| Total Medical Submitted Charge Amount | 466470 |
| Total Medical Medicare Allowed Amount | 154971.29 |
| Total Medical Medicare Payment Amount | 121769.15 |
| Total Medical Medicare Standardized Payment Amount | 127222.67 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 870 |
| Number Of Beneficiaries Age 65 to 74 | 1393 |
| Number Of Beneficiaries Age 75 to 84 | 1182 |
| Number Of Beneficiaries Age Greater 84 | 634 |
| Number Of Female Beneficiaries | 2512 |
| Number Of Male Beneficiaries | 1567 |
| Number Of Non Hispanic White Beneficiaries | 3629 |
| Number Of Black or African American Beneficiaries | 236 |
| Number Of AsianPacific Islander Beneficiaries | 29 |
| Number Of Hispanic Beneficiaries | 128 |
| Number Of American Indian Alaska Native Beneficiaries | 32 |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3066 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1013 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6098 |