| National Provider Identifier [NPI]: | 1669625885 |
| Last Name Of The Provider | WENDT |
| First Name Of The Provider | TARA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | HSC LEVEL 4 ROOM 080 - DEPT OF EMERGENCY MEDICINE |
| Street Address 2 Of The Provider | STONY BROOK UNIV. MEDICAL CENTER |
| City Of The Provider | STONY BROOK |
| Zip Code Of The Provider | 117548350 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 1753 |
| Number Of Medicare Beneficiaries | 1180 |
| Total Submitted Charge Amount | 912566 |
| Total Medicare Allowed Amount | 200454.93 |
| Total Medicare Payment Amount | 154750.69 |
| Total Medicare Standardized Payment Amount | 151970.63 |
| 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 | 34 |
| Number Of Medical Services | 1753 |
| Number Of Medicare Beneficiaries With Medical Services | 1180 |
| Total Medical Submitted Charge Amount | 912566 |
| Total Medical Medicare Allowed Amount | 200454.93 |
| Total Medical Medicare Payment Amount | 154750.69 |
| Total Medical Medicare Standardized Payment Amount | 151970.63 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 169 |
| Number Of Beneficiaries Age 65 to 74 | 255 |
| Number Of Beneficiaries Age 75 to 84 | 420 |
| Number Of Beneficiaries Age Greater 84 | 336 |
| Number Of Female Beneficiaries | 670 |
| Number Of Male Beneficiaries | 510 |
| Number Of Non Hispanic White Beneficiaries | 1056 |
| Number Of Black or African American Beneficiaries | 74 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 897 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 283 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.9113 |