| National Provider Identifier [NPI]: | 1558305540 |
| Last Name Of The Provider | WAMBOLDT |
| First Name Of The Provider | ALAN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7525 E BROADWAY RD |
| Street Address 2 Of The Provider | SUITE 3 |
| City Of The Provider | MESA |
| Zip Code Of The Provider | 852082002 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 7009 |
| Number Of Medicare Beneficiaries | 959 |
| Total Submitted Charge Amount | 662248 |
| Total Medicare Allowed Amount | 380942.48 |
| Total Medicare Payment Amount | 278956.73 |
| Total Medicare Standardized Payment Amount | 280102.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2211 |
| Number Of Medicare Beneficiaries With Drug Services | 478 |
| Total Drug Submitted ChargeAmount | 86055 |
| Total Drug Medicare AllowedAmount | 21940.94 |
| Total Drug Medicare PaymentAmount | 16880.01 |
| Total Drug Medicare Standardized Payment Amount | 16880.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 4798 |
| Number Of Medicare Beneficiaries With Medical Services | 959 |
| Total Medical Submitted Charge Amount | 576193 |
| Total Medical Medicare Allowed Amount | 359001.54 |
| Total Medical Medicare Payment Amount | 262076.72 |
| Total Medical Medicare Standardized Payment Amount | 263222.43 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 361 |
| Number Of Beneficiaries Age 75 to 84 | 398 |
| Number Of Beneficiaries Age Greater 84 | 177 |
| Number Of Female Beneficiaries | 578 |
| Number Of Male Beneficiaries | 381 |
| Number Of Non Hispanic White Beneficiaries | 912 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 946 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0603 |