| National Provider Identifier [NPI]: | 1902005747 |
| Last Name Of The Provider | WALLACE |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3421 BENSON AVE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212271056 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 2144 |
| Number Of Medicare Beneficiaries | 421 |
| Total Submitted Charge Amount | 559987.97 |
| Total Medicare Allowed Amount | 163750.17 |
| Total Medicare Payment Amount | 123040.29 |
| Total Medicare Standardized Payment Amount | 113023.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 148 |
| Number Of Medicare Beneficiaries With Drug Services | 89 |
| Total Drug Submitted ChargeAmount | 12638.25 |
| Total Drug Medicare AllowedAmount | 4325.78 |
| Total Drug Medicare PaymentAmount | 3386.9 |
| Total Drug Medicare Standardized Payment Amount | 3386.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 1996 |
| Number Of Medicare Beneficiaries With Medical Services | 421 |
| Total Medical Submitted Charge Amount | 547349.72 |
| Total Medical Medicare Allowed Amount | 159424.39 |
| Total Medical Medicare Payment Amount | 119653.39 |
| Total Medical Medicare Standardized Payment Amount | 109636.19 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 71 |
| Number Of Beneficiaries Age 65 to 74 | 195 |
| Number Of Beneficiaries Age 75 to 84 | 113 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 269 |
| Number Of Male Beneficiaries | 152 |
| Number Of Non Hispanic White Beneficiaries | 293 |
| Number Of Black or African American Beneficiaries | 96 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 365 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 56 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 66 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0537 |