| National Provider Identifier [NPI]: | 1497819098 |
| Last Name Of The Provider | HOLLOWAY |
| First Name Of The Provider | WADE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 259 JONESBORO RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MCDONOUGH |
| Zip Code Of The Provider | 302533769 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 120 |
| Number Of Medicare Beneficiaries | 37 |
| Total Submitted Charge Amount | 8326 |
| Total Medicare Allowed Amount | 3795.35 |
| Total Medicare Payment Amount | 2992.95 |
| Total Medicare Standardized Payment Amount | 3670.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 56 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 592 |
| Total Drug Medicare AllowedAmount | 90.31 |
| Total Drug Medicare PaymentAmount | 70.83 |
| Total Drug Medicare Standardized Payment Amount | 70.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 64 |
| Number Of Medicare Beneficiaries With Medical Services | 37 |
| Total Medical Submitted Charge Amount | 7734 |
| Total Medical Medicare Allowed Amount | 3705.04 |
| Total Medical Medicare Payment Amount | 2922.12 |
| Total Medical Medicare Standardized Payment Amount | 3599.47 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 13 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 20 |
| Number Of Male Beneficiaries | 17 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5391 |