| National Provider Identifier [NPI]: | 1801884382 |
| Last Name Of The Provider | TAKATA |
| First Name Of The Provider | THEODORE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1300 W TERRELL AVE |
| Street Address 2 Of The Provider | #500 |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 761042800 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiac Electrophysiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 5038 |
| Number Of Medicare Beneficiaries | 1168 |
| Total Submitted Charge Amount | 1086791 |
| Total Medicare Allowed Amount | 371946.24 |
| Total Medicare Payment Amount | 274815.94 |
| Total Medicare Standardized Payment Amount | 284380.09 |
| 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 | 87 |
| Number Of Medical Services | 5038 |
| Number Of Medicare Beneficiaries With Medical Services | 1168 |
| Total Medical Submitted Charge Amount | 1086791 |
| Total Medical Medicare Allowed Amount | 371946.24 |
| Total Medical Medicare Payment Amount | 274815.94 |
| Total Medical Medicare Standardized Payment Amount | 284380.09 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 74 |
| Number Of Beneficiaries Age 65 to 74 | 321 |
| Number Of Beneficiaries Age 75 to 84 | 442 |
| Number Of Beneficiaries Age Greater 84 | 331 |
| Number Of Female Beneficiaries | 511 |
| Number Of Male Beneficiaries | 657 |
| Number Of Non Hispanic White Beneficiaries | 1051 |
| Number Of Black or African American Beneficiaries | 59 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1059 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 109 |
| Percent Of With Atrial Fibrillation | 45 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 56 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.8448 |