| National Provider Identifier [NPI]: | 1982608717 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8737 BEVERLY BLVD |
| Street Address 2 Of The Provider | STE 302 |
| City Of The Provider | WEST HOLLYWOOD |
| Zip Code Of The Provider | 900481840 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 115008 |
| Number Of Medicare Beneficiaries | 552 |
| Total Submitted Charge Amount | 3462666.12 |
| Total Medicare Allowed Amount | 1297253.92 |
| Total Medicare Payment Amount | 979413.17 |
| Total Medicare Standardized Payment Amount | 968680.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 29 |
| Number Of Drug Services | 102515 |
| Number Of Medicare Beneficiaries With Drug Services | 295 |
| Total Drug Submitted ChargeAmount | 2435156.12 |
| Total Drug Medicare AllowedAmount | 940334.3 |
| Total Drug Medicare PaymentAmount | 702960.79 |
| Total Drug Medicare Standardized Payment Amount | 702960.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 58 |
| Number Of Medical Services | 12493 |
| Number Of Medicare Beneficiaries With Medical Services | 552 |
| Total Medical Submitted Charge Amount | 1027510 |
| Total Medical Medicare Allowed Amount | 356919.62 |
| Total Medical Medicare Payment Amount | 276452.38 |
| Total Medical Medicare Standardized Payment Amount | 265719.61 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 176 |
| Number Of Beneficiaries Age 65 to 74 | 249 |
| Number Of Beneficiaries Age 75 to 84 | 99 |
| Number Of Beneficiaries Age Greater 84 | 28 |
| Number Of Female Beneficiaries | 485 |
| Number Of Male Beneficiaries | 67 |
| Number Of Non Hispanic White Beneficiaries | 411 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | 52 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 458 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 94 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 66 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.3013 |