| National Provider Identifier [NPI]: | 1336251560 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | EMERSON |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | CFNP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1154 CROSS CREEK DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALTILLO |
| Zip Code Of The Provider | 388665777 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 6315 |
| Number Of Medicare Beneficiaries | 416 |
| Total Submitted Charge Amount | 271836 |
| Total Medicare Allowed Amount | 123537.95 |
| Total Medicare Payment Amount | 84181.92 |
| Total Medicare Standardized Payment Amount | 109755.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 19 |
| Number Of Drug Services | 3149 |
| Number Of Medicare Beneficiaries With Drug Services | 292 |
| Total Drug Submitted ChargeAmount | 44778 |
| Total Drug Medicare AllowedAmount | 3325.52 |
| Total Drug Medicare PaymentAmount | 2722.42 |
| Total Drug Medicare Standardized Payment Amount | 2722.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 76 |
| Number Of Medical Services | 3166 |
| Number Of Medicare Beneficiaries With Medical Services | 414 |
| Total Medical Submitted Charge Amount | 227058 |
| Total Medical Medicare Allowed Amount | 120212.43 |
| Total Medical Medicare Payment Amount | 81459.5 |
| Total Medical Medicare Standardized Payment Amount | 107033.31 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 105 |
| Number Of Beneficiaries Age 65 to 74 | 186 |
| Number Of Beneficiaries Age 75 to 84 | 95 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 237 |
| Number Of Male Beneficiaries | 179 |
| Number Of Non Hispanic White Beneficiaries | 372 |
| 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 | 297 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 119 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9698 |