| National Provider Identifier [NPI]: | 1831198811 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1100 BROOKHAVEN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FRANKLIN |
| Zip Code Of The Provider | 421342746 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 209 |
| Number Of Services | 5466 |
| Number Of Medicare Beneficiaries | 3300 |
| Total Submitted Charge Amount | 626547 |
| Total Medicare Allowed Amount | 171532.16 |
| Total Medicare Payment Amount | 128206.18 |
| Total Medicare Standardized Payment Amount | 135771.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 209 |
| Number Of Medical Services | 5466 |
| Number Of Medicare Beneficiaries With Medical Services | 3300 |
| Total Medical Submitted Charge Amount | 626547 |
| Total Medical Medicare Allowed Amount | 171532.16 |
| Total Medical Medicare Payment Amount | 128206.18 |
| Total Medical Medicare Standardized Payment Amount | 135771.88 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 899 |
| Number Of Beneficiaries Age 65 to 74 | 1141 |
| Number Of Beneficiaries Age 75 to 84 | 843 |
| Number Of Beneficiaries Age Greater 84 | 417 |
| Number Of Female Beneficiaries | 1888 |
| Number Of Male Beneficiaries | 1412 |
| Number Of Non Hispanic White Beneficiaries | 3041 |
| Number Of Black or African American Beneficiaries | 222 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1950 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1350 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.7487 |