| National Provider Identifier [NPI]: | 1417156811 |
| Last Name Of The Provider | TAN |
| First Name Of The Provider | JESSICA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 505 PARNASSUS AVE |
| Street Address 2 Of The Provider | L-371 |
| City Of The Provider | SAN FRANCISCO |
| Zip Code Of The Provider | 941432204 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 122 |
| Number Of Services | 1690 |
| Number Of Medicare Beneficiaries | 1132 |
| Total Submitted Charge Amount | 406455 |
| Total Medicare Allowed Amount | 76003.23 |
| Total Medicare Payment Amount | 54217.38 |
| Total Medicare Standardized Payment Amount | 48843.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 122 |
| Number Of Medical Services | 1690 |
| Number Of Medicare Beneficiaries With Medical Services | 1132 |
| Total Medical Submitted Charge Amount | 406455 |
| Total Medical Medicare Allowed Amount | 76003.23 |
| Total Medical Medicare Payment Amount | 54217.38 |
| Total Medical Medicare Standardized Payment Amount | 48843.13 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 216 |
| Number Of Beneficiaries Age 65 to 74 | 364 |
| Number Of Beneficiaries Age 75 to 84 | 337 |
| Number Of Beneficiaries Age Greater 84 | 215 |
| Number Of Female Beneficiaries | 596 |
| Number Of Male Beneficiaries | 536 |
| Number Of Non Hispanic White Beneficiaries | 600 |
| Number Of Black or African American Beneficiaries | 123 |
| Number Of AsianPacific Islander Beneficiaries | 271 |
| Number Of Hispanic Beneficiaries | 114 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 507 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 625 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.6197 |