| National Provider Identifier [NPI]: | 1265446017 |
| Last Name Of The Provider | TACK |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 501 N RIVERSIDE DR |
| Street Address 2 Of The Provider | SUITE 102 |
| City Of The Provider | GURNEE |
| Zip Code Of The Provider | 600315918 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 2571 |
| Number Of Medicare Beneficiaries | 477 |
| Total Submitted Charge Amount | 497568 |
| Total Medicare Allowed Amount | 202808.59 |
| Total Medicare Payment Amount | 155682.63 |
| Total Medicare Standardized Payment Amount | 148199.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 31 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 1240 |
| Total Drug Medicare AllowedAmount | 214.61 |
| Total Drug Medicare PaymentAmount | 203.64 |
| Total Drug Medicare Standardized Payment Amount | 203.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 2540 |
| Number Of Medicare Beneficiaries With Medical Services | 477 |
| Total Medical Submitted Charge Amount | 496328 |
| Total Medical Medicare Allowed Amount | 202593.98 |
| Total Medical Medicare Payment Amount | 155478.99 |
| Total Medical Medicare Standardized Payment Amount | 147995.41 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 84 |
| Number Of Beneficiaries Age 65 to 74 | 151 |
| Number Of Beneficiaries Age 75 to 84 | 144 |
| Number Of Beneficiaries Age Greater 84 | 98 |
| Number Of Female Beneficiaries | 281 |
| Number Of Male Beneficiaries | 196 |
| Number Of Non Hispanic White Beneficiaries | 386 |
| Number Of Black or African American Beneficiaries | 75 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 343 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 134 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.0211 |