| National Provider Identifier [NPI]: | 1477572865 |
| Last Name Of The Provider | THALER |
| First Name Of The Provider | BRUCE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 110 S FRONT ST UNIT 800 |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191063065 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 132 |
| Number Of Services | 3762 |
| Number Of Medicare Beneficiaries | 2354 |
| Total Submitted Charge Amount | 321671.66 |
| Total Medicare Allowed Amount | 112285.29 |
| Total Medicare Payment Amount | 88876.73 |
| Total Medicare Standardized Payment Amount | 85149.1 |
| 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 | 132 |
| Number Of Medical Services | 3762 |
| Number Of Medicare Beneficiaries With Medical Services | 2354 |
| Total Medical Submitted Charge Amount | 321671.66 |
| Total Medical Medicare Allowed Amount | 112285.29 |
| Total Medical Medicare Payment Amount | 88876.73 |
| Total Medical Medicare Standardized Payment Amount | 85149.1 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 488 |
| Number Of Beneficiaries Age 65 to 74 | 986 |
| Number Of Beneficiaries Age 75 to 84 | 576 |
| Number Of Beneficiaries Age Greater 84 | 304 |
| Number Of Female Beneficiaries | 1656 |
| Number Of Male Beneficiaries | 698 |
| Number Of Non Hispanic White Beneficiaries | 1820 |
| Number Of Black or African American Beneficiaries | 458 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 42 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1792 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 562 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5335 |