| National Provider Identifier [NPI]: | 1619273042 |
| Last Name Of The Provider | WHELAN |
| First Name Of The Provider | TARA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 45 WELLS ST |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | WESTERLY |
| Zip Code Of The Provider | 028912961 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 1534 |
| Number Of Medicare Beneficiaries | 391 |
| Total Submitted Charge Amount | 285820.01 |
| Total Medicare Allowed Amount | 133727.67 |
| Total Medicare Payment Amount | 97682.76 |
| Total Medicare Standardized Payment Amount | 90570.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 21 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 60.01 |
| Total Drug Medicare AllowedAmount | 35.81 |
| Total Drug Medicare PaymentAmount | 25.23 |
| Total Drug Medicare Standardized Payment Amount | 25.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 66 |
| Number Of Medical Services | 1513 |
| Number Of Medicare Beneficiaries With Medical Services | 391 |
| Total Medical Submitted Charge Amount | 285760 |
| Total Medical Medicare Allowed Amount | 133691.86 |
| Total Medical Medicare Payment Amount | 97657.53 |
| Total Medical Medicare Standardized Payment Amount | 90545.33 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 88 |
| Number Of Beneficiaries Age 65 to 74 | 158 |
| Number Of Beneficiaries Age 75 to 84 | 94 |
| Number Of Beneficiaries Age Greater 84 | 51 |
| Number Of Female Beneficiaries | 243 |
| Number Of Male Beneficiaries | 148 |
| Number Of Non Hispanic White Beneficiaries | 345 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 251 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 140 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1848 |