| National Provider Identifier [NPI]: | 1417946203 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | ROY |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 345 23RD AVE N |
| Street Address 2 Of The Provider | SUITE 350 |
| City Of The Provider | NASHVILLE |
| Zip Code Of The Provider | 372031596 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 20303 |
| Number Of Medicare Beneficiaries | 1789 |
| Total Submitted Charge Amount | 13491023 |
| Total Medicare Allowed Amount | 5315155.09 |
| Total Medicare Payment Amount | 4044183.2 |
| Total Medicare Standardized Payment Amount | 4128494.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 9521 |
| Number Of Medicare Beneficiaries With Drug Services | 637 |
| Total Drug Submitted ChargeAmount | 10737155 |
| Total Drug Medicare AllowedAmount | 4285270.01 |
| Total Drug Medicare PaymentAmount | 3306105.58 |
| Total Drug Medicare Standardized Payment Amount | 3306105.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 10782 |
| Number Of Medicare Beneficiaries With Medical Services | 1789 |
| Total Medical Submitted Charge Amount | 2753868 |
| Total Medical Medicare Allowed Amount | 1029885.08 |
| Total Medical Medicare Payment Amount | 738077.62 |
| Total Medical Medicare Standardized Payment Amount | 822388.79 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 147 |
| Number Of Beneficiaries Age 65 to 74 | 582 |
| Number Of Beneficiaries Age 75 to 84 | 630 |
| Number Of Beneficiaries Age Greater 84 | 430 |
| Number Of Female Beneficiaries | 1053 |
| Number Of Male Beneficiaries | 736 |
| Number Of Non Hispanic White Beneficiaries | 1624 |
| Number Of Black or African American Beneficiaries | 134 |
| 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 | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1615 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 174 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4404 |