| National Provider Identifier [NPI]: | 1003098807 |
| Last Name Of The Provider | DEWALCH |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 S BECKHAM AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TYLER |
| Zip Code Of The Provider | 757011908 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 893 |
| Number Of Medicare Beneficiaries | 258 |
| Total Submitted Charge Amount | 238054 |
| Total Medicare Allowed Amount | 69088.36 |
| Total Medicare Payment Amount | 53361.48 |
| Total Medicare Standardized Payment Amount | 57073.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 262 |
| Number Of Medicare Beneficiaries With Drug Services | 97 |
| Total Drug Submitted ChargeAmount | 72693 |
| Total Drug Medicare AllowedAmount | 28625.19 |
| Total Drug Medicare PaymentAmount | 22071.1 |
| Total Drug Medicare Standardized Payment Amount | 22071.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 631 |
| Number Of Medicare Beneficiaries With Medical Services | 258 |
| Total Medical Submitted Charge Amount | 165361 |
| Total Medical Medicare Allowed Amount | 40463.17 |
| Total Medical Medicare Payment Amount | 31290.38 |
| Total Medical Medicare Standardized Payment Amount | 35002.23 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 117 |
| Number Of Beneficiaries Age 75 to 84 | 69 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 173 |
| Number Of Male Beneficiaries | 85 |
| Number Of Non Hispanic White Beneficiaries | 221 |
| Number Of Black or African American Beneficiaries | 25 |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 194 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 64 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6997 |