| National Provider Identifier [NPI]: | 1265475206 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | TRACEY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3525 PIEDMONT RD NE |
| Street Address 2 Of The Provider | BLDG 7-601 |
| City Of The Provider | ATLANTA |
| Zip Code Of The Provider | 303051578 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 3518 |
| Number Of Medicare Beneficiaries | 1044 |
| Total Submitted Charge Amount | 328254.6 |
| Total Medicare Allowed Amount | 207246.68 |
| Total Medicare Payment Amount | 142969.7 |
| Total Medicare Standardized Payment Amount | 144982.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 17 |
| Number Of Drug Services | 354 |
| Number Of Medicare Beneficiaries With Drug Services | 261 |
| Total Drug Submitted ChargeAmount | 17691 |
| Total Drug Medicare AllowedAmount | 5968.06 |
| Total Drug Medicare PaymentAmount | 5608.58 |
| Total Drug Medicare Standardized Payment Amount | 5608.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 3164 |
| Number Of Medicare Beneficiaries With Medical Services | 1044 |
| Total Medical Submitted Charge Amount | 310563.6 |
| Total Medical Medicare Allowed Amount | 201278.62 |
| Total Medical Medicare Payment Amount | 137361.12 |
| Total Medical Medicare Standardized Payment Amount | 139373.6 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 562 |
| Number Of Beneficiaries Age 75 to 84 | 312 |
| Number Of Beneficiaries Age Greater 84 | 133 |
| Number Of Female Beneficiaries | 654 |
| Number Of Male Beneficiaries | 390 |
| Number Of Non Hispanic White Beneficiaries | 963 |
| Number Of Black or African American Beneficiaries | 31 |
| 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 | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1011 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.7977 |