| National Provider Identifier [NPI]: | 1578591657 |
| Last Name Of The Provider | MILLER |
| First Name Of The Provider | WALLACE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3400 SPRUCE ST |
| Street Address 2 Of The Provider | GROUND FLOOR DULLES |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 19104 |
| 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 | 39 |
| Number Of Services | 7456 |
| Number Of Medicare Beneficiaries | 4166 |
| Total Submitted Charge Amount | 591843 |
| Total Medicare Allowed Amount | 176549.29 |
| Total Medicare Payment Amount | 133209.69 |
| Total Medicare Standardized Payment Amount | 129754.72 |
| 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 | 39 |
| Number Of Medical Services | 7456 |
| Number Of Medicare Beneficiaries With Medical Services | 4166 |
| Total Medical Submitted Charge Amount | 591843 |
| Total Medical Medicare Allowed Amount | 176549.29 |
| Total Medical Medicare Payment Amount | 133209.69 |
| Total Medical Medicare Standardized Payment Amount | 129754.72 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 878 |
| Number Of Beneficiaries Age 65 to 74 | 1883 |
| Number Of Beneficiaries Age 75 to 84 | 1045 |
| Number Of Beneficiaries Age Greater 84 | 360 |
| Number Of Female Beneficiaries | 1978 |
| Number Of Male Beneficiaries | 2188 |
| Number Of Non Hispanic White Beneficiaries | 3076 |
| Number Of Black or African American Beneficiaries | 821 |
| Number Of AsianPacific Islander Beneficiaries | 98 |
| Number Of Hispanic Beneficiaries | 80 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 91 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3307 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 859 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 29 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.3144 |