| National Provider Identifier [NPI]: | 1912092859 |
| Last Name Of The Provider | TAN |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12050 S RIVIERA |
| Street Address 2 Of The Provider | |
| City Of The Provider | TUSTIN |
| Zip Code Of The Provider | 927821205 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 191 |
| Number Of Services | 6612 |
| Number Of Medicare Beneficiaries | 2433 |
| Total Submitted Charge Amount | 775911.66 |
| Total Medicare Allowed Amount | 218587.62 |
| Total Medicare Payment Amount | 174127.13 |
| Total Medicare Standardized Payment Amount | 159941.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1890 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 788.7 |
| Total Drug Medicare AllowedAmount | 596.83 |
| Total Drug Medicare PaymentAmount | 467.95 |
| Total Drug Medicare Standardized Payment Amount | 467.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 188 |
| Number Of Medical Services | 4722 |
| Number Of Medicare Beneficiaries With Medical Services | 2433 |
| Total Medical Submitted Charge Amount | 775122.96 |
| Total Medical Medicare Allowed Amount | 217990.79 |
| Total Medical Medicare Payment Amount | 173659.18 |
| Total Medical Medicare Standardized Payment Amount | 159473.58 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 298 |
| Number Of Beneficiaries Age 65 to 74 | 723 |
| Number Of Beneficiaries Age 75 to 84 | 748 |
| Number Of Beneficiaries Age Greater 84 | 664 |
| Number Of Female Beneficiaries | 1496 |
| Number Of Male Beneficiaries | 937 |
| Number Of Non Hispanic White Beneficiaries | 1131 |
| Number Of Black or African American Beneficiaries | 99 |
| Number Of AsianPacific Islander Beneficiaries | 626 |
| Number Of Hispanic Beneficiaries | 531 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1197 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1236 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 33 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.219 |