| National Provider Identifier [NPI]: | 1578598074 |
| Last Name Of The Provider | BOOMER |
| First Name Of The Provider | WALTER |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6485 S YALE |
| Street Address 2 Of The Provider | SUITE 1200 |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 74136 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 4382 |
| Number Of Medicare Beneficiaries | 986 |
| Total Submitted Charge Amount | 745298 |
| Total Medicare Allowed Amount | 343563.07 |
| Total Medicare Payment Amount | 261211.12 |
| Total Medicare Standardized Payment Amount | 281446.31 |
| Drug Suppress Indicator | * |
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| Number Of Medicare Beneficiaries With Drug Services | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
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| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 162 |
| Number Of Beneficiaries Age 65 to 74 | 421 |
| Number Of Beneficiaries Age 75 to 84 | 309 |
| Number Of Beneficiaries Age Greater 84 | 94 |
| Number Of Female Beneficiaries | 528 |
| Number Of Male Beneficiaries | 458 |
| Number Of Non Hispanic White Beneficiaries | 823 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 94 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 781 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 205 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 26 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 63 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.1806 |