| National Provider Identifier [NPI]: | 1114983095 |
| Last Name Of The Provider | WALLER |
| First Name Of The Provider | BRUCE |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8333 NAAB RD STE 400 |
| Street Address 2 Of The Provider | |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462601992 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 113 |
| Number Of Services | 77772 |
| Number Of Medicare Beneficiaries | 12716 |
| Total Submitted Charge Amount | 5779925 |
| Total Medicare Allowed Amount | 1262493.52 |
| Total Medicare Payment Amount | 1165085.79 |
| Total Medicare Standardized Payment Amount | 1189826.47 |
| Drug Suppress Indicator | * |
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| Total Drug Submitted ChargeAmount | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 801 |
| Number Of Beneficiaries Age 65 to 74 | 5552 |
| Number Of Beneficiaries Age 75 to 84 | 4341 |
| Number Of Beneficiaries Age Greater 84 | 2022 |
| Number Of Female Beneficiaries | 7042 |
| Number Of Male Beneficiaries | 5674 |
| Number Of Non Hispanic White Beneficiaries | 11176 |
| Number Of Black or African American Beneficiaries | 1133 |
| Number Of AsianPacific Islander Beneficiaries | 125 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 203 |
| Number Of Beneficiaries With Medicare Only Entitlement | 11763 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 953 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0809 |