| National Provider Identifier [NPI]: | 1114952074 |
| Last Name Of The Provider | WALTERS |
| First Name Of The Provider | FREDERICK |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12345 W BEND DR |
| Street Address 2 Of The Provider | SUITE200 |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631282104 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 92 |
| Number Of Services | 3513 |
| Number Of Medicare Beneficiaries | 729 |
| Total Submitted Charge Amount | 698014.04 |
| Total Medicare Allowed Amount | 322429.15 |
| Total Medicare Payment Amount | 237189.94 |
| Total Medicare Standardized Payment Amount | 246616.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 1106 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 238430.4 |
| Total Drug Medicare AllowedAmount | 89776.19 |
| Total Drug Medicare PaymentAmount | 70249.65 |
| Total Drug Medicare Standardized Payment Amount | 70249.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 81 |
| Number Of Medical Services | 2407 |
| Number Of Medicare Beneficiaries With Medical Services | 729 |
| Total Medical Submitted Charge Amount | 459583.64 |
| Total Medical Medicare Allowed Amount | 232652.96 |
| Total Medical Medicare Payment Amount | 166940.29 |
| Total Medical Medicare Standardized Payment Amount | 176366.44 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 61 |
| Number Of Beneficiaries Age 65 to 74 | 309 |
| Number Of Beneficiaries Age 75 to 84 | 253 |
| Number Of Beneficiaries Age Greater 84 | 106 |
| Number Of Female Beneficiaries | 137 |
| Number Of Male Beneficiaries | 592 |
| Number Of Non Hispanic White Beneficiaries | 708 |
| 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 | 692 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 27 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3141 |