| National Provider Identifier [NPI]: | 1952321200 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | DONNA |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | A.N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 920 E 28TH ST |
| Street Address 2 Of The Provider | SUITE 700 |
| City Of The Provider | MINNEAPOLIS |
| Zip Code Of The Provider | 554071139 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 541 |
| Number Of Medicare Beneficiaries | 385 |
| Total Submitted Charge Amount | 69854.16 |
| Total Medicare Allowed Amount | 30719.29 |
| Total Medicare Payment Amount | 21179.65 |
| Total Medicare Standardized Payment Amount | 26655.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 21 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 294 |
| Total Drug Medicare AllowedAmount | 294 |
| Total Drug Medicare PaymentAmount | 288.12 |
| Total Drug Medicare Standardized Payment Amount | 288.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 520 |
| Number Of Medicare Beneficiaries With Medical Services | 385 |
| Total Medical Submitted Charge Amount | 69560.16 |
| Total Medical Medicare Allowed Amount | 30425.29 |
| Total Medical Medicare Payment Amount | 20891.53 |
| Total Medical Medicare Standardized Payment Amount | 26367.02 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 122 |
| Number Of Beneficiaries Age 65 to 74 | 145 |
| Number Of Beneficiaries Age 75 to 84 | 93 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 185 |
| Number Of Male Beneficiaries | 200 |
| Number Of Non Hispanic White Beneficiaries | 345 |
| Number Of Black or African American Beneficiaries | 21 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 288 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 97 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0824 |