| National Provider Identifier [NPI]: | 1649295833 |
| Last Name Of The Provider | SHORT |
| First Name Of The Provider | WALTER |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 225 E JACKSON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | JONESBORO |
| Zip Code Of The Provider | 724013119 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 1206 |
| Number Of Medicare Beneficiaries | 744 |
| Total Submitted Charge Amount | 434490 |
| Total Medicare Allowed Amount | 116880.37 |
| Total Medicare Payment Amount | 90758.29 |
| Total Medicare Standardized Payment Amount | 93934.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 45 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 355 |
| Total Drug Medicare AllowedAmount | 59.11 |
| Total Drug Medicare PaymentAmount | 48.74 |
| Total Drug Medicare Standardized Payment Amount | 48.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 1161 |
| Number Of Medicare Beneficiaries With Medical Services | 744 |
| Total Medical Submitted Charge Amount | 434135 |
| Total Medical Medicare Allowed Amount | 116821.26 |
| Total Medical Medicare Payment Amount | 90709.55 |
| Total Medical Medicare Standardized Payment Amount | 93885.67 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 288 |
| Number Of Beneficiaries Age 65 to 74 | 196 |
| Number Of Beneficiaries Age 75 to 84 | 163 |
| Number Of Beneficiaries Age Greater 84 | 97 |
| Number Of Female Beneficiaries | 463 |
| Number Of Male Beneficiaries | 281 |
| Number Of Non Hispanic White Beneficiaries | 660 |
| Number Of Black or African American Beneficiaries | 68 |
| 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 | 273 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 471 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 44 |
| Percent Of With Depression | 49 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.8597 |