| National Provider Identifier [NPI]: | 1629011226 |
| Last Name Of The Provider | POLHAMUS |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1400 JOHNSTON WILLIS DR |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | RICHMOND |
| Zip Code Of The Provider | 232354765 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 1889 |
| Number Of Medicare Beneficiaries | 332 |
| Total Submitted Charge Amount | 263263 |
| Total Medicare Allowed Amount | 97733.19 |
| Total Medicare Payment Amount | 74207.49 |
| Total Medicare Standardized Payment Amount | 81253.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 921 |
| Number Of Medicare Beneficiaries With Drug Services | 141 |
| Total Drug Submitted ChargeAmount | 44541 |
| Total Drug Medicare AllowedAmount | 35966.45 |
| Total Drug Medicare PaymentAmount | 27774.48 |
| Total Drug Medicare Standardized Payment Amount | 27774.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 968 |
| Number Of Medicare Beneficiaries With Medical Services | 332 |
| Total Medical Submitted Charge Amount | 218722 |
| Total Medical Medicare Allowed Amount | 61766.74 |
| Total Medical Medicare Payment Amount | 46433.01 |
| Total Medical Medicare Standardized Payment Amount | 53479.09 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 199 |
| Number Of Beneficiaries Age 75 to 84 | 99 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 233 |
| Number Of Male Beneficiaries | 99 |
| Number Of Non Hispanic White Beneficiaries | 255 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 319 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0374 |