| National Provider Identifier [NPI]: | 1154619849 |
| Last Name Of The Provider | TABASSUM |
| First Name Of The Provider | RANA |
| 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 | 6071 W OUTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | DETROIT |
| Zip Code Of The Provider | 482352624 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 5 |
| Number Of Services | 358 |
| Number Of Medicare Beneficiaries | 94 |
| Total Submitted Charge Amount | 12745.76 |
| Total Medicare Allowed Amount | 12632.27 |
| Total Medicare Payment Amount | 9740.49 |
| Total Medicare Standardized Payment Amount | 13308.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 72 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 1211.76 |
| Total Drug Medicare AllowedAmount | 1108.8 |
| Total Drug Medicare PaymentAmount | 1086.48 |
| Total Drug Medicare Standardized Payment Amount | 1086.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 4 |
| Number Of Medical Services | 286 |
| Number Of Medicare Beneficiaries With Medical Services | 93 |
| Total Medical Submitted Charge Amount | 11534 |
| Total Medical Medicare Allowed Amount | 11523.47 |
| Total Medical Medicare Payment Amount | 8654.01 |
| Total Medical Medicare Standardized Payment Amount | 12221.7 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 72 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 32 |
| Number Of Male Beneficiaries | 62 |
| Number Of Non Hispanic White Beneficiaries | 81 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 0 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 26 |
| Percent Of With Hypertension | 24 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 28 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.049 |