| National Provider Identifier [NPI]: | 1336115799 |
| Last Name Of The Provider | OLD |
| First Name Of The Provider | WAYNE |
| 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 | 612 KINGSBOROUGH SQ |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | CHESAPEAKE |
| Zip Code Of The Provider | 233205041 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 3042 |
| Number Of Medicare Beneficiaries | 1024 |
| Total Submitted Charge Amount | 563194.49 |
| Total Medicare Allowed Amount | 265455.25 |
| Total Medicare Payment Amount | 199953.56 |
| Total Medicare Standardized Payment Amount | 209085.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 146 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 8579.16 |
| Total Drug Medicare AllowedAmount | 7434.52 |
| Total Drug Medicare PaymentAmount | 5568.48 |
| Total Drug Medicare Standardized Payment Amount | 5568.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 2896 |
| Number Of Medicare Beneficiaries With Medical Services | 1024 |
| Total Medical Submitted Charge Amount | 554615.33 |
| Total Medical Medicare Allowed Amount | 258020.73 |
| Total Medical Medicare Payment Amount | 194385.08 |
| Total Medical Medicare Standardized Payment Amount | 203517.22 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 151 |
| Number Of Beneficiaries Age 65 to 74 | 429 |
| Number Of Beneficiaries Age 75 to 84 | 301 |
| Number Of Beneficiaries Age Greater 84 | 143 |
| Number Of Female Beneficiaries | 431 |
| Number Of Male Beneficiaries | 593 |
| Number Of Non Hispanic White Beneficiaries | 763 |
| Number Of Black or African American Beneficiaries | 228 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 873 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 151 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 51 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.078 |