| National Provider Identifier [NPI]: | 1801864327 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 939 CAROLINE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT ANGELES |
| Zip Code Of The Provider | 983623909 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 1655 |
| Number Of Medicare Beneficiaries | 1269 |
| Total Submitted Charge Amount | 296726.15 |
| Total Medicare Allowed Amount | 150321.6 |
| Total Medicare Payment Amount | 111600.07 |
| Total Medicare Standardized Payment Amount | 114584.21 |
| 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 | 36 |
| Number Of Medical Services | 1655 |
| Number Of Medicare Beneficiaries With Medical Services | 1269 |
| Total Medical Submitted Charge Amount | 296726.15 |
| Total Medical Medicare Allowed Amount | 150321.6 |
| Total Medical Medicare Payment Amount | 111600.07 |
| Total Medical Medicare Standardized Payment Amount | 114584.21 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 246 |
| Number Of Beneficiaries Age 65 to 74 | 344 |
| Number Of Beneficiaries Age 75 to 84 | 364 |
| Number Of Beneficiaries Age Greater 84 | 315 |
| Number Of Female Beneficiaries | 692 |
| Number Of Male Beneficiaries | 577 |
| Number Of Non Hispanic White Beneficiaries | 1174 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | 50 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 940 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 329 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.413 |