| National Provider Identifier [NPI]: | 1306868534 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | KACEY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2100 W IOWA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICKASHA |
| Zip Code Of The Provider | 730182736 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 146 |
| Number Of Services | 7929 |
| Number Of Medicare Beneficiaries | 636 |
| Total Submitted Charge Amount | 557714.8 |
| Total Medicare Allowed Amount | 256186.05 |
| Total Medicare Payment Amount | 196562.54 |
| Total Medicare Standardized Payment Amount | 211003.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 423 |
| Number Of Medicare Beneficiaries With Drug Services | 137 |
| Total Drug Submitted ChargeAmount | 5924.6 |
| Total Drug Medicare AllowedAmount | 2946.9 |
| Total Drug Medicare PaymentAmount | 2772.68 |
| Total Drug Medicare Standardized Payment Amount | 2772.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 134 |
| Number Of Medical Services | 7506 |
| Number Of Medicare Beneficiaries With Medical Services | 636 |
| Total Medical Submitted Charge Amount | 551790.2 |
| Total Medical Medicare Allowed Amount | 253239.15 |
| Total Medical Medicare Payment Amount | 193789.86 |
| Total Medical Medicare Standardized Payment Amount | 208230.39 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 83 |
| Number Of Beneficiaries Age 65 to 74 | 231 |
| Number Of Beneficiaries Age 75 to 84 | 209 |
| Number Of Beneficiaries Age Greater 84 | 113 |
| Number Of Female Beneficiaries | 437 |
| Number Of Male Beneficiaries | 199 |
| Number Of Non Hispanic White Beneficiaries | 576 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 33 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 465 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 171 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4168 |