| National Provider Identifier [NPI]: | 1578561767 |
| Last Name Of The Provider | TANNA |
| First Name Of The Provider | SHITAL |
| 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 | 1710 N RANDALL ROAD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | ELGIN |
| Zip Code Of The Provider | 601234717 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 1335 |
| Number Of Medicare Beneficiaries | 105 |
| Total Submitted Charge Amount | 97783 |
| Total Medicare Allowed Amount | 60219.22 |
| Total Medicare Payment Amount | 44467.78 |
| Total Medicare Standardized Payment Amount | 42777.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 75 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 3684 |
| Total Drug Medicare AllowedAmount | 1786.85 |
| Total Drug Medicare PaymentAmount | 1742.33 |
| Total Drug Medicare Standardized Payment Amount | 1742.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 1260 |
| Number Of Medicare Beneficiaries With Medical Services | 105 |
| Total Medical Submitted Charge Amount | 94099 |
| Total Medical Medicare Allowed Amount | 58432.37 |
| Total Medical Medicare Payment Amount | 42725.45 |
| Total Medical Medicare Standardized Payment Amount | 41034.9 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 63 |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 65 |
| Number Of Male Beneficiaries | 40 |
| Number Of Non Hispanic White Beneficiaries | 82 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0062 |