National Provider Identifier [NPI]: |
1881851558 |
Last Name Of The Provider |
TALLEY |
First Name Of The Provider |
MELINDA |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1210 W 18TH ST |
Street Address 2 Of The Provider |
STE LL03 |
City Of The Provider |
SIOUX FALLS |
Zip Code Of The Provider |
571044647 |
State Code Of The Provider |
SD |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
59 |
Number Of Services |
3963 |
Number Of Medicare Beneficiaries |
1992 |
Total Submitted Charge Amount |
1168670 |
Total Medicare Allowed Amount |
315388.5 |
Total Medicare Payment Amount |
281383.02 |
Total Medicare Standardized Payment Amount |
285318.27 |
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 |
59 |
Number Of Medical Services |
3963 |
Number Of Medicare Beneficiaries With Medical Services |
1992 |
Total Medical Submitted Charge Amount |
1168670 |
Total Medical Medicare Allowed Amount |
315388.5 |
Total Medical Medicare Payment Amount |
281383.02 |
Total Medical Medicare Standardized Payment Amount |
285318.27 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
235 |
Number Of Beneficiaries Age 65 to 74 |
1029 |
Number Of Beneficiaries Age 75 to 84 |
556 |
Number Of Beneficiaries Age Greater 84 |
172 |
Number Of Female Beneficiaries |
1870 |
Number Of Male Beneficiaries |
122 |
Number Of Non Hispanic White Beneficiaries |
1922 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
11 |
Number Of American Indian Alaska Native Beneficiaries |
28 |
Number Of Beneficiaries With Race Not Else where Classified |
13 |
Number Of Beneficiaries With Medicare Only Entitlement |
1727 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
265 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
50 |
Percent Of With Hypertension |
56 |
Percent Of With Ischemic Heart Disease |
21 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
0.9551 |