| National Provider Identifier [NPI]: | 1518051366 |
| Last Name Of The Provider | HOLLOPETER |
| First Name Of The Provider | WAYNE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 721 W. NORTH STREET |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRANGEVILLE |
| Zip Code Of The Provider | 83530 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 83 |
| Number Of Services | 2324 |
| Number Of Medicare Beneficiaries | 326 |
| Total Submitted Charge Amount | 138625.96 |
| Total Medicare Allowed Amount | 119982.45 |
| Total Medicare Payment Amount | 87874.46 |
| Total Medicare Standardized Payment Amount | 99259.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 685 |
| Number Of Medicare Beneficiaries With Drug Services | 160 |
| Total Drug Submitted ChargeAmount | 2830.25 |
| Total Drug Medicare AllowedAmount | 2708.23 |
| Total Drug Medicare PaymentAmount | 2413.83 |
| Total Drug Medicare Standardized Payment Amount | 2413.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 78 |
| Number Of Medical Services | 1639 |
| Number Of Medicare Beneficiaries With Medical Services | 326 |
| Total Medical Submitted Charge Amount | 135795.71 |
| Total Medical Medicare Allowed Amount | 117274.22 |
| Total Medical Medicare Payment Amount | 85460.63 |
| Total Medical Medicare Standardized Payment Amount | 96846.03 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 165 |
| Number Of Beneficiaries Age 75 to 84 | 94 |
| Number Of Beneficiaries Age Greater 84 | 54 |
| Number Of Female Beneficiaries | 162 |
| Number Of Male Beneficiaries | 164 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 301 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 6 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 40 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7956 |