| National Provider Identifier [NPI]: | 1457553885 |
| Last Name Of The Provider | TANNENBAUM |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1808 SCENIC DR |
| Street Address 2 Of The Provider | APT 107 |
| City Of The Provider | MODESTO |
| Zip Code Of The Provider | 95355 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 330 |
| Number Of Medicare Beneficiaries | 151 |
| Total Submitted Charge Amount | 47705 |
| Total Medicare Allowed Amount | 17754.99 |
| Total Medicare Payment Amount | 13250.17 |
| Total Medicare Standardized Payment Amount | 15564.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 53 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 1128 |
| Total Drug Medicare AllowedAmount | 66.77 |
| Total Drug Medicare PaymentAmount | 52.36 |
| Total Drug Medicare Standardized Payment Amount | 52.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 277 |
| Number Of Medicare Beneficiaries With Medical Services | 151 |
| Total Medical Submitted Charge Amount | 46577 |
| Total Medical Medicare Allowed Amount | 17688.22 |
| Total Medical Medicare Payment Amount | 13197.81 |
| Total Medical Medicare Standardized Payment Amount | 15511.99 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 36 |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 94 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | 134 |
| 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 | 118 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9701 |