| National Provider Identifier [NPI]: | 1659488690 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2801 W KINNICKINNIC RIVER PKWY |
| Street Address 2 Of The Provider | #250 |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 53215 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 1050 |
| Number Of Medicare Beneficiaries | 367 |
| Total Submitted Charge Amount | 219551.15 |
| Total Medicare Allowed Amount | 69511.16 |
| Total Medicare Payment Amount | 51710.23 |
| Total Medicare Standardized Payment Amount | 53913.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 105 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 2330.15 |
| Total Drug Medicare AllowedAmount | 1214.89 |
| Total Drug Medicare PaymentAmount | 1149.28 |
| Total Drug Medicare Standardized Payment Amount | 1149.28 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 945 |
| Number Of Medicare Beneficiaries With Medical Services | 367 |
| Total Medical Submitted Charge Amount | 217221 |
| Total Medical Medicare Allowed Amount | 68296.27 |
| Total Medical Medicare Payment Amount | 50560.95 |
| Total Medical Medicare Standardized Payment Amount | 52764.12 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 146 |
| Number Of Beneficiaries Age 65 to 74 | 112 |
| Number Of Beneficiaries Age 75 to 84 | 74 |
| Number Of Beneficiaries Age Greater 84 | 35 |
| Number Of Female Beneficiaries | 203 |
| Number Of Male Beneficiaries | 164 |
| Number Of Non Hispanic White Beneficiaries | 199 |
| Number Of Black or African American Beneficiaries | 47 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 102 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 145 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 222 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7412 |