| National Provider Identifier [NPI]: | 1922327485 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | HENRY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10301 KANIS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LITTLE ROCK |
| Zip Code Of The Provider | 722056205 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 121 |
| Number Of Services | 5775 |
| Number Of Medicare Beneficiaries | 879 |
| Total Submitted Charge Amount | 1224770 |
| Total Medicare Allowed Amount | 386748.53 |
| Total Medicare Payment Amount | 286301.77 |
| Total Medicare Standardized Payment Amount | 315202.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 2651 |
| Number Of Medicare Beneficiaries With Drug Services | 392 |
| Total Drug Submitted ChargeAmount | 79976 |
| Total Drug Medicare AllowedAmount | 28791.05 |
| Total Drug Medicare PaymentAmount | 22372.76 |
| Total Drug Medicare Standardized Payment Amount | 22372.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 115 |
| Number Of Medical Services | 3124 |
| Number Of Medicare Beneficiaries With Medical Services | 879 |
| Total Medical Submitted Charge Amount | 1144794 |
| Total Medical Medicare Allowed Amount | 357957.48 |
| Total Medical Medicare Payment Amount | 263929.01 |
| Total Medical Medicare Standardized Payment Amount | 292829.81 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 146 |
| Number Of Beneficiaries Age 65 to 74 | 367 |
| Number Of Beneficiaries Age 75 to 84 | 257 |
| Number Of Beneficiaries Age Greater 84 | 109 |
| Number Of Female Beneficiaries | 554 |
| Number Of Male Beneficiaries | 325 |
| Number Of Non Hispanic White Beneficiaries | 865 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 704 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 175 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 62 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9784 |