| National Provider Identifier [NPI]: | 1407812407 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | BILLI |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4321 WASHINGTON |
| Street Address 2 Of The Provider | STE 2100 |
| City Of The Provider | KANSAS CITY |
| Zip Code Of The Provider | 64111 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 659 |
| Number Of Medicare Beneficiaries | 303 |
| Total Submitted Charge Amount | 84775 |
| Total Medicare Allowed Amount | 58377.48 |
| Total Medicare Payment Amount | 39980.02 |
| Total Medicare Standardized Payment Amount | 44198.12 |
| Drug Suppress Indicator | * |
| Number Of HCPCS Associated With Drug Services | |
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| Number Of Medicare Beneficiaries With Drug Services | |
| Total Drug Submitted ChargeAmount | |
| Total Drug Medicare AllowedAmount | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
| Number Of Medical Services | |
| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | 122 |
| Number Of Beneficiaries Age 75 to 84 | 74 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 195 |
| Number Of Male Beneficiaries | 108 |
| Number Of Non Hispanic White Beneficiaries | 269 |
| Number Of Black or African American Beneficiaries | 23 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 269 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.2379 |