| National Provider Identifier [NPI]: | 1497894117 |
| Last Name Of The Provider | WALL |
| First Name Of The Provider | PHILLY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 32ND ST NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CEDAR RAPIDS |
| Zip Code Of The Provider | 524024204 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 154 |
| Number Of Medicare Beneficiaries | 98 |
| Total Submitted Charge Amount | 17678 |
| Total Medicare Allowed Amount | 8383.61 |
| Total Medicare Payment Amount | 6635.2 |
| Total Medicare Standardized Payment Amount | 8276.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 614 |
| Total Drug Medicare AllowedAmount | 324.48 |
| Total Drug Medicare PaymentAmount | 317.47 |
| Total Drug Medicare Standardized Payment Amount | 317.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 139 |
| Number Of Medicare Beneficiaries With Medical Services | 97 |
| Total Medical Submitted Charge Amount | 17064 |
| Total Medical Medicare Allowed Amount | 8059.13 |
| Total Medical Medicare Payment Amount | 6317.73 |
| Total Medical Medicare Standardized Payment Amount | 7958.93 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 38 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 57 |
| Number Of Male Beneficiaries | 41 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 77 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.9701 |