| National Provider Identifier [NPI]: | 1104813013 |
| Last Name Of The Provider | TANI |
| First Name Of The Provider | JASON |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4540 E BASELINE RD |
| Street Address 2 Of The Provider | #119 |
| City Of The Provider | MESA |
| Zip Code Of The Provider | 852064617 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 143 |
| Number Of Services | 1675 |
| Number Of Medicare Beneficiaries | 418 |
| Total Submitted Charge Amount | 557199.9 |
| Total Medicare Allowed Amount | 252365.65 |
| Total Medicare Payment Amount | 195339.85 |
| Total Medicare Standardized Payment Amount | 197441.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 338 |
| Number Of Medicare Beneficiaries With Drug Services | 64 |
| Total Drug Submitted ChargeAmount | 3313.9 |
| Total Drug Medicare AllowedAmount | 1756.62 |
| Total Drug Medicare PaymentAmount | 1309.36 |
| Total Drug Medicare Standardized Payment Amount | 1309.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 138 |
| Number Of Medical Services | 1337 |
| Number Of Medicare Beneficiaries With Medical Services | 418 |
| Total Medical Submitted Charge Amount | 553886 |
| Total Medical Medicare Allowed Amount | 250609.03 |
| Total Medical Medicare Payment Amount | 194030.49 |
| Total Medical Medicare Standardized Payment Amount | 196131.79 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 143 |
| Number Of Beneficiaries Age 75 to 84 | 137 |
| Number Of Beneficiaries Age Greater 84 | 99 |
| Number Of Female Beneficiaries | 266 |
| Number Of Male Beneficiaries | 152 |
| Number Of Non Hispanic White Beneficiaries | 375 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 368 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 50 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7011 |