| National Provider Identifier [NPI]: | 1689846909 |
| Last Name Of The Provider | WHANG |
| First Name Of The Provider | TALLEY |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 S ROGERS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BLOOMINGTON |
| Zip Code Of The Provider | 474034792 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 4051 |
| Number Of Medicare Beneficiaries | 1720 |
| Total Submitted Charge Amount | 716223.42 |
| Total Medicare Allowed Amount | 267708.46 |
| Total Medicare Payment Amount | 200868.41 |
| Total Medicare Standardized Payment Amount | 180551.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 30 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 4937.42 |
| Total Drug Medicare AllowedAmount | 4636.86 |
| Total Drug Medicare PaymentAmount | 3520.07 |
| Total Drug Medicare Standardized Payment Amount | 3520.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 4021 |
| Number Of Medicare Beneficiaries With Medical Services | 1720 |
| Total Medical Submitted Charge Amount | 711286 |
| Total Medical Medicare Allowed Amount | 263071.6 |
| Total Medical Medicare Payment Amount | 197348.34 |
| Total Medical Medicare Standardized Payment Amount | 177031.87 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 112 |
| Number Of Beneficiaries Age 65 to 74 | 766 |
| Number Of Beneficiaries Age 75 to 84 | 572 |
| Number Of Beneficiaries Age Greater 84 | 270 |
| Number Of Female Beneficiaries | 816 |
| Number Of Male Beneficiaries | 904 |
| Number Of Non Hispanic White Beneficiaries | 1648 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1574 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 146 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0368 |