| National Provider Identifier [NPI]: | 1184780728 |
| Last Name Of The Provider | WALL |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4033 TALBOT RD S |
| Street Address 2 Of The Provider | SUITE 500 |
| City Of The Provider | RENTON |
| Zip Code Of The Provider | 98055 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 2933 |
| Number Of Medicare Beneficiaries | 603 |
| Total Submitted Charge Amount | 430076.86 |
| Total Medicare Allowed Amount | 199899.65 |
| Total Medicare Payment Amount | 151905.41 |
| Total Medicare Standardized Payment Amount | 145046.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 668 |
| Number Of Medicare Beneficiaries With Drug Services | 43 |
| Total Drug Submitted ChargeAmount | 2425 |
| Total Drug Medicare AllowedAmount | 1238.88 |
| Total Drug Medicare PaymentAmount | 1151.31 |
| Total Drug Medicare Standardized Payment Amount | 1151.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 66 |
| Number Of Medical Services | 2265 |
| Number Of Medicare Beneficiaries With Medical Services | 603 |
| Total Medical Submitted Charge Amount | 427651.86 |
| Total Medical Medicare Allowed Amount | 198660.77 |
| Total Medical Medicare Payment Amount | 150754.1 |
| Total Medical Medicare Standardized Payment Amount | 143894.94 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 102 |
| Number Of Beneficiaries Age 65 to 74 | 227 |
| Number Of Beneficiaries Age 75 to 84 | 203 |
| Number Of Beneficiaries Age Greater 84 | 71 |
| Number Of Female Beneficiaries | 319 |
| Number Of Male Beneficiaries | 284 |
| Number Of Non Hispanic White Beneficiaries | 492 |
| Number Of Black or African American Beneficiaries | 40 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 468 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 135 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 47 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.7349 |