| National Provider Identifier [NPI]: | 1922064906 |
| Last Name Of The Provider | HOLLAWAY |
| First Name Of The Provider | STACEY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4810 MUNSON ST NW |
| Street Address 2 Of The Provider | |
| City Of The Provider | CANTON |
| Zip Code Of The Provider | 447183613 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 1434 |
| Number Of Medicare Beneficiaries | 243 |
| Total Submitted Charge Amount | 93114 |
| Total Medicare Allowed Amount | 75134.51 |
| Total Medicare Payment Amount | 57058.84 |
| Total Medicare Standardized Payment Amount | 59374.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 155 |
| Number Of Medicare Beneficiaries With Drug Services | 94 |
| Total Drug Submitted ChargeAmount | 7673 |
| Total Drug Medicare AllowedAmount | 4932.68 |
| Total Drug Medicare PaymentAmount | 4614.15 |
| Total Drug Medicare Standardized Payment Amount | 4614.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 1279 |
| Number Of Medicare Beneficiaries With Medical Services | 243 |
| Total Medical Submitted Charge Amount | 85441 |
| Total Medical Medicare Allowed Amount | 70201.83 |
| Total Medical Medicare Payment Amount | 52444.69 |
| Total Medical Medicare Standardized Payment Amount | 54760.19 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 106 |
| Number Of Beneficiaries Age 75 to 84 | 70 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 175 |
| Number Of Male Beneficiaries | 68 |
| Number Of Non Hispanic White Beneficiaries | 231 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 218 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1004 |