| National Provider Identifier [NPI]: | 1700920154 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11700 MERCY BLVD |
| Street Address 2 Of The Provider | BUILDING 6 |
| City Of The Provider | SAVANNAH |
| Zip Code Of The Provider | 314191753 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 5037 |
| Number Of Medicare Beneficiaries | 1228 |
| Total Submitted Charge Amount | 1244373.08 |
| Total Medicare Allowed Amount | 414404.96 |
| Total Medicare Payment Amount | 305417.61 |
| Total Medicare Standardized Payment Amount | 333934.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 369 |
| Number Of Medicare Beneficiaries With Drug Services | 93 |
| Total Drug Submitted ChargeAmount | 27775 |
| Total Drug Medicare AllowedAmount | 19535.44 |
| Total Drug Medicare PaymentAmount | 14305.47 |
| Total Drug Medicare Standardized Payment Amount | 14305.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 4668 |
| Number Of Medicare Beneficiaries With Medical Services | 1228 |
| Total Medical Submitted Charge Amount | 1216598.08 |
| Total Medical Medicare Allowed Amount | 394869.52 |
| Total Medical Medicare Payment Amount | 291112.14 |
| Total Medical Medicare Standardized Payment Amount | 319628.69 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 166 |
| Number Of Beneficiaries Age 65 to 74 | 523 |
| Number Of Beneficiaries Age 75 to 84 | 364 |
| Number Of Beneficiaries Age Greater 84 | 175 |
| Number Of Female Beneficiaries | 622 |
| Number Of Male Beneficiaries | 606 |
| Number Of Non Hispanic White Beneficiaries | 969 |
| Number Of Black or African American Beneficiaries | 219 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 963 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 265 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.527 |