| National Provider Identifier [NPI]: | 1033359393 |
| Last Name Of The Provider | VASHAKMADZE |
| First Name Of The Provider | TAMARA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4850 E MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432133162 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 1119 |
| Number Of Medicare Beneficiaries | 397 |
| Total Submitted Charge Amount | 180496 |
| Total Medicare Allowed Amount | 123643.62 |
| Total Medicare Payment Amount | 95169.61 |
| Total Medicare Standardized Payment Amount | 97487.77 |
| 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 | 18 |
| Number Of Medical Services | 1119 |
| Number Of Medicare Beneficiaries With Medical Services | 397 |
| Total Medical Submitted Charge Amount | 180496 |
| Total Medical Medicare Allowed Amount | 123643.62 |
| Total Medical Medicare Payment Amount | 95169.61 |
| Total Medical Medicare Standardized Payment Amount | 97487.77 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 147 |
| Number Of Beneficiaries Age 65 to 74 | 93 |
| Number Of Beneficiaries Age 75 to 84 | 96 |
| Number Of Beneficiaries Age Greater 84 | 61 |
| Number Of Female Beneficiaries | 213 |
| Number Of Male Beneficiaries | 184 |
| Number Of Non Hispanic White Beneficiaries | 355 |
| 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 | 196 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 201 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 44 |
| Percent Of With Depression | 51 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 22 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0855 |