| National Provider Identifier [NPI]: | 1629117023 |
| Last Name Of The Provider | DOLEZAL |
| First Name Of The Provider | JOSEPH |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | OD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1125 MELLEN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CENTRALIA |
| Zip Code Of The Provider | 985311173 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 775 |
| Number Of Medicare Beneficiaries | 498 |
| Total Submitted Charge Amount | 92442 |
| Total Medicare Allowed Amount | 72050.54 |
| Total Medicare Payment Amount | 48415.68 |
| Total Medicare Standardized Payment Amount | 50651.43 |
| 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 | 14 |
| Number Of Medical Services | 775 |
| Number Of Medicare Beneficiaries With Medical Services | 498 |
| Total Medical Submitted Charge Amount | 92442 |
| Total Medical Medicare Allowed Amount | 72050.54 |
| Total Medical Medicare Payment Amount | 48415.68 |
| Total Medical Medicare Standardized Payment Amount | 50651.43 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 110 |
| Number Of Beneficiaries Age 65 to 74 | 168 |
| Number Of Beneficiaries Age 75 to 84 | 135 |
| Number Of Beneficiaries Age Greater 84 | 85 |
| Number Of Female Beneficiaries | 304 |
| Number Of Male Beneficiaries | 194 |
| Number Of Non Hispanic White Beneficiaries | 465 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 362 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 136 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0883 |