| National Provider Identifier [NPI]: | 1194747402 |
| Last Name Of The Provider | SCHALLEN |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| 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 | BUILDING 300 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322164252 |
| 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 | 193 |
| Number Of Services | 6301 |
| Number Of Medicare Beneficiaries | 4554 |
| Total Submitted Charge Amount | 1024909 |
| Total Medicare Allowed Amount | 253343.13 |
| Total Medicare Payment Amount | 194926.89 |
| Total Medicare Standardized Payment Amount | 195456.41 |
| 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 | 193 |
| Number Of Medical Services | 6301 |
| Number Of Medicare Beneficiaries With Medical Services | 4554 |
| Total Medical Submitted Charge Amount | 1024909 |
| Total Medical Medicare Allowed Amount | 253343.13 |
| Total Medical Medicare Payment Amount | 194926.89 |
| Total Medical Medicare Standardized Payment Amount | 195456.41 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 812 |
| Number Of Beneficiaries Age 65 to 74 | 1789 |
| Number Of Beneficiaries Age 75 to 84 | 1280 |
| Number Of Beneficiaries Age Greater 84 | 673 |
| Number Of Female Beneficiaries | 2775 |
| Number Of Male Beneficiaries | 1779 |
| Number Of Non Hispanic White Beneficiaries | 3654 |
| Number Of Black or African American Beneficiaries | 692 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 116 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 46 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3521 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1033 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.8638 |