| National Provider Identifier [NPI]: | 1700821147 |
| Last Name Of The Provider | TALLEY |
| First Name Of The Provider | BRAD |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3599 UNIVERSITY BLVD. S. |
| Street Address 2 Of The Provider | BLDG. 300 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 32216 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 180 |
| Number Of Services | 8468 |
| Number Of Medicare Beneficiaries | 5991 |
| Total Submitted Charge Amount | 1080880 |
| Total Medicare Allowed Amount | 260581.89 |
| Total Medicare Payment Amount | 198370.85 |
| Total Medicare Standardized Payment Amount | 199089.94 |
| 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 | 180 |
| Number Of Medical Services | 8468 |
| Number Of Medicare Beneficiaries With Medical Services | 5991 |
| Total Medical Submitted Charge Amount | 1080880 |
| Total Medical Medicare Allowed Amount | 260581.89 |
| Total Medical Medicare Payment Amount | 198370.85 |
| Total Medical Medicare Standardized Payment Amount | 199089.94 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 1089 |
| Number Of Beneficiaries Age 65 to 74 | 2223 |
| Number Of Beneficiaries Age 75 to 84 | 1689 |
| Number Of Beneficiaries Age Greater 84 | 990 |
| Number Of Female Beneficiaries | 3711 |
| Number Of Male Beneficiaries | 2280 |
| Number Of Non Hispanic White Beneficiaries | 4760 |
| Number Of Black or African American Beneficiaries | 893 |
| Number Of AsianPacific Islander Beneficiaries | 79 |
| Number Of Hispanic Beneficiaries | 187 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 4459 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1532 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.9615 |