| National Provider Identifier [NPI]: | 1992826358 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | DANYALE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1901 W POLK STREET |
| Street Address 2 Of The Provider | FLOOR 10 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 60612 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 1180 |
| Number Of Medicare Beneficiaries | 952 |
| Total Submitted Charge Amount | 820439 |
| Total Medicare Allowed Amount | 195377.63 |
| Total Medicare Payment Amount | 147028.47 |
| Total Medicare Standardized Payment Amount | 135087.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 1180 |
| Number Of Medicare Beneficiaries With Medical Services | 952 |
| Total Medical Submitted Charge Amount | 820439 |
| Total Medical Medicare Allowed Amount | 195377.63 |
| Total Medical Medicare Payment Amount | 147028.47 |
| Total Medical Medicare Standardized Payment Amount | 135087.76 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 269 |
| Number Of Beneficiaries Age 65 to 74 | 250 |
| Number Of Beneficiaries Age 75 to 84 | 277 |
| Number Of Beneficiaries Age Greater 84 | 156 |
| Number Of Female Beneficiaries | 582 |
| Number Of Male Beneficiaries | 370 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 793 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 80 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 408 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 544 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 22 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 54 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 60 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.686 |