| National Provider Identifier [NPI]: | 1003007907 |
| Last Name Of The Provider | TAVAN |
| First Name Of The Provider | EMMANUEL |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2800 N VANCOUVER AVE |
| Street Address 2 Of The Provider | SUITE 230 |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 972271630 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 759 |
| Number Of Medicare Beneficiaries | 269 |
| Total Submitted Charge Amount | 165516.25 |
| Total Medicare Allowed Amount | 60821.63 |
| Total Medicare Payment Amount | 46554.03 |
| Total Medicare Standardized Payment Amount | 47004.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 42 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 2485.5 |
| Total Drug Medicare AllowedAmount | 2484.57 |
| Total Drug Medicare PaymentAmount | 2434.75 |
| Total Drug Medicare Standardized Payment Amount | 2434.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 717 |
| Number Of Medicare Beneficiaries With Medical Services | 269 |
| Total Medical Submitted Charge Amount | 163030.75 |
| Total Medical Medicare Allowed Amount | 58337.06 |
| Total Medical Medicare Payment Amount | 44119.28 |
| Total Medical Medicare Standardized Payment Amount | 44570.08 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 106 |
| Number Of Beneficiaries Age 75 to 84 | 73 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 147 |
| Number Of Male Beneficiaries | 122 |
| Number Of Non Hispanic White Beneficiaries | 235 |
| Number Of Black or African American Beneficiaries | 18 |
| 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 | 191 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 78 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 23 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 55 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 2.0046 |