| National Provider Identifier [NPI]: | 1518966688 |
| Last Name Of The Provider | WALLER |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4868 BRIDGE RD |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | SUFFOLK |
| Zip Code Of The Provider | 234352048 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 83 |
| Number Of Services | 1731 |
| Number Of Medicare Beneficiaries | 401 |
| Total Submitted Charge Amount | 176096.5 |
| Total Medicare Allowed Amount | 111262.63 |
| Total Medicare Payment Amount | 74866.2 |
| Total Medicare Standardized Payment Amount | 77868.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 124 |
| Number Of Medicare Beneficiaries With Drug Services | 103 |
| Total Drug Submitted ChargeAmount | 4226.5 |
| Total Drug Medicare AllowedAmount | 2358.02 |
| Total Drug Medicare PaymentAmount | 2259.73 |
| Total Drug Medicare Standardized Payment Amount | 2259.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 1607 |
| Number Of Medicare Beneficiaries With Medical Services | 401 |
| Total Medical Submitted Charge Amount | 171870 |
| Total Medical Medicare Allowed Amount | 108904.61 |
| Total Medical Medicare Payment Amount | 72606.47 |
| Total Medical Medicare Standardized Payment Amount | 75608.98 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 203 |
| Number Of Beneficiaries Age 75 to 84 | 94 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 211 |
| Number Of Male Beneficiaries | 190 |
| Number Of Non Hispanic White Beneficiaries | 316 |
| Number Of Black or African American Beneficiaries | |
| 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 | 360 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1143 |