| National Provider Identifier [NPI]: | 1639113293 |
| Last Name Of The Provider | HALLER |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4853 GALAXY PKWY |
| Street Address 2 Of The Provider | SUITE I |
| City Of The Provider | CLEVELAND |
| Zip Code Of The Provider | 441285973 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 187 |
| Number Of Services | 5233 |
| Number Of Medicare Beneficiaries | 2932 |
| Total Submitted Charge Amount | 971769 |
| Total Medicare Allowed Amount | 145640.03 |
| Total Medicare Payment Amount | 112600.75 |
| Total Medicare Standardized Payment Amount | 115330.44 |
| 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 | 187 |
| Number Of Medical Services | 5233 |
| Number Of Medicare Beneficiaries With Medical Services | 2932 |
| Total Medical Submitted Charge Amount | 971769 |
| Total Medical Medicare Allowed Amount | 145640.03 |
| Total Medical Medicare Payment Amount | 112600.75 |
| Total Medical Medicare Standardized Payment Amount | 115330.44 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 323 |
| Number Of Beneficiaries Age 65 to 74 | 870 |
| Number Of Beneficiaries Age 75 to 84 | 954 |
| Number Of Beneficiaries Age Greater 84 | 785 |
| Number Of Female Beneficiaries | 1754 |
| Number Of Male Beneficiaries | 1178 |
| Number Of Non Hispanic White Beneficiaries | 2790 |
| Number Of Black or African American Beneficiaries | 45 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2409 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 523 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.817 |