| National Provider Identifier [NPI]: | 1114912011 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 160 WYOMING ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | DAYTON |
| Zip Code Of The Provider | 454092740 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 3301 |
| Number Of Medicare Beneficiaries | 905 |
| Total Submitted Charge Amount | 612794.8 |
| Total Medicare Allowed Amount | 174768.27 |
| Total Medicare Payment Amount | 134855.96 |
| Total Medicare Standardized Payment Amount | 104339.93 |
| Drug Suppress Indicator | * |
| Number Of HCPCS Associated With Drug Services | |
| Number Of Drug Services | |
| Number Of Medicare Beneficiaries With Drug Services | |
| Total Drug Submitted ChargeAmount | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| 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 | 70 |
| Number Of Beneficiaries Age Less65 | 154 |
| Number Of Beneficiaries Age 65 to 74 | 444 |
| Number Of Beneficiaries Age 75 to 84 | 252 |
| Number Of Beneficiaries Age Greater 84 | 55 |
| Number Of Female Beneficiaries | 489 |
| Number Of Male Beneficiaries | 416 |
| Number Of Non Hispanic White Beneficiaries | 750 |
| Number Of Black or African American Beneficiaries | 126 |
| 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 | 731 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 174 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3623 |