| National Provider Identifier [NPI]: | 1730134313 |
| Last Name Of The Provider | STALLER |
| First Name Of The Provider | BRETT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 201 E SAMPLE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | POMPANO BEACH |
| Zip Code Of The Provider | 330643502 |
| 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 | 220 |
| Number Of Services | 5654 |
| Number Of Medicare Beneficiaries | 3541 |
| Total Submitted Charge Amount | 794979.19 |
| Total Medicare Allowed Amount | 173688.48 |
| Total Medicare Payment Amount | 130942.06 |
| Total Medicare Standardized Payment Amount | 126722.78 |
| 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 | 220 |
| Number Of Medical Services | 5654 |
| Number Of Medicare Beneficiaries With Medical Services | 3541 |
| Total Medical Submitted Charge Amount | 794979.19 |
| Total Medical Medicare Allowed Amount | 173688.48 |
| Total Medical Medicare Payment Amount | 130942.06 |
| Total Medical Medicare Standardized Payment Amount | 126722.78 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 792 |
| Number Of Beneficiaries Age 65 to 74 | 1220 |
| Number Of Beneficiaries Age 75 to 84 | 836 |
| Number Of Beneficiaries Age Greater 84 | 693 |
| Number Of Female Beneficiaries | 2018 |
| Number Of Male Beneficiaries | 1523 |
| Number Of Non Hispanic White Beneficiaries | 2449 |
| Number Of Black or African American Beneficiaries | 702 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 280 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 62 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2273 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1268 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.0019 |