| National Provider Identifier [NPI]: | 1134438286 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 831 N THEATRE DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARION |
| Zip Code Of The Provider | 469521701 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 552 |
| Number Of Medicare Beneficiaries | 259 |
| Total Submitted Charge Amount | 53522 |
| Total Medicare Allowed Amount | 32910.49 |
| Total Medicare Payment Amount | 24163.26 |
| Total Medicare Standardized Payment Amount | 30299.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 908 |
| Total Drug Medicare AllowedAmount | 637.3 |
| Total Drug Medicare PaymentAmount | 623.53 |
| Total Drug Medicare Standardized Payment Amount | 623.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 524 |
| Number Of Medicare Beneficiaries With Medical Services | 259 |
| Total Medical Submitted Charge Amount | 52614 |
| Total Medical Medicare Allowed Amount | 32273.19 |
| Total Medical Medicare Payment Amount | 23539.73 |
| Total Medical Medicare Standardized Payment Amount | 29675.6 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 81 |
| Number Of Beneficiaries Age 75 to 84 | 82 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 171 |
| Number Of Male Beneficiaries | 88 |
| Number Of Non Hispanic White Beneficiaries | 245 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 225 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4528 |