| National Provider Identifier [NPI]: | 1861489049 |
| Last Name Of The Provider | WALLIS |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6 DOCTOR CIR |
| Street Address 2 Of The Provider | |
| City Of The Provider | LONGVIEW |
| Zip Code Of The Provider | 756055050 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 102 |
| Number Of Services | 12933 |
| Number Of Medicare Beneficiaries | 1727 |
| Total Submitted Charge Amount | 1207924.5 |
| Total Medicare Allowed Amount | 1013137.2 |
| Total Medicare Payment Amount | 762497.34 |
| Total Medicare Standardized Payment Amount | 758252.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 494 |
| Number Of Medicare Beneficiaries With Drug Services | 192 |
| Total Drug Submitted ChargeAmount | 131052.36 |
| Total Drug Medicare AllowedAmount | 94248.14 |
| Total Drug Medicare PaymentAmount | 71491.03 |
| Total Drug Medicare Standardized Payment Amount | 71491.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 100 |
| Number Of Medical Services | 12439 |
| Number Of Medicare Beneficiaries With Medical Services | 1727 |
| Total Medical Submitted Charge Amount | 1076872.14 |
| Total Medical Medicare Allowed Amount | 918889.06 |
| Total Medical Medicare Payment Amount | 691006.31 |
| Total Medical Medicare Standardized Payment Amount | 686761 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 78 |
| Number Of Beneficiaries Age 65 to 74 | 714 |
| Number Of Beneficiaries Age 75 to 84 | 621 |
| Number Of Beneficiaries Age Greater 84 | 314 |
| Number Of Female Beneficiaries | 780 |
| Number Of Male Beneficiaries | 947 |
| Number Of Non Hispanic White Beneficiaries | 1671 |
| Number Of Black or African American Beneficiaries | 30 |
| 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 | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1625 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 102 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0892 |