| National Provider Identifier [NPI]: | 1790828663 |
| Last Name Of The Provider | WALLEN |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 292 FRANTZ RD |
| Street Address 2 Of The Provider | SUITE 108 |
| City Of The Provider | STROUDSBURG |
| Zip Code Of The Provider | 183607455 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 1108 |
| Number Of Medicare Beneficiaries | 357 |
| Total Submitted Charge Amount | 118522 |
| Total Medicare Allowed Amount | 68230.62 |
| Total Medicare Payment Amount | 44554.52 |
| Total Medicare Standardized Payment Amount | 47111.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 35 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 850 |
| Total Drug Medicare AllowedAmount | 535.86 |
| Total Drug Medicare PaymentAmount | 524.45 |
| Total Drug Medicare Standardized Payment Amount | 524.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 1073 |
| Number Of Medicare Beneficiaries With Medical Services | 357 |
| Total Medical Submitted Charge Amount | 117672 |
| Total Medical Medicare Allowed Amount | 67694.76 |
| Total Medical Medicare Payment Amount | 44030.07 |
| Total Medical Medicare Standardized Payment Amount | 46587.27 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 114 |
| Number Of Beneficiaries Age 65 to 74 | 146 |
| Number Of Beneficiaries Age 75 to 84 | 71 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 197 |
| Number Of Male Beneficiaries | 160 |
| Number Of Non Hispanic White Beneficiaries | 252 |
| Number Of Black or African American Beneficiaries | 52 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 42 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 245 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 112 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.1947 |