| National Provider Identifier [NPI]: | 1982687687 |
| Last Name Of The Provider | HARLEY |
| First Name Of The Provider | BRUCE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5215 HOLY CROSS PKWY |
| Street Address 2 Of The Provider | EMERGENCY DEPARTMENT |
| City Of The Provider | MISHAWAKA |
| Zip Code Of The Provider | 465451469 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 1701 |
| Number Of Medicare Beneficiaries | 999 |
| Total Submitted Charge Amount | 838338 |
| Total Medicare Allowed Amount | 166232.09 |
| Total Medicare Payment Amount | 129864.56 |
| Total Medicare Standardized Payment Amount | 134848.23 |
| 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 | 37 |
| Number Of Medical Services | 1701 |
| Number Of Medicare Beneficiaries With Medical Services | 999 |
| Total Medical Submitted Charge Amount | 838338 |
| Total Medical Medicare Allowed Amount | 166232.09 |
| Total Medical Medicare Payment Amount | 129864.56 |
| Total Medical Medicare Standardized Payment Amount | 134848.23 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 283 |
| Number Of Beneficiaries Age 65 to 74 | 240 |
| Number Of Beneficiaries Age 75 to 84 | 256 |
| Number Of Beneficiaries Age Greater 84 | 220 |
| Number Of Female Beneficiaries | 606 |
| Number Of Male Beneficiaries | 393 |
| Number Of Non Hispanic White Beneficiaries | 849 |
| Number Of Black or African American Beneficiaries | 101 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 626 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 373 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.0036 |