| National Provider Identifier [NPI]: | 1437109709 |
| Last Name Of The Provider | WISTOW |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 600 COFFEE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MODESTO |
| Zip Code Of The Provider | 953554201 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 98 |
| Number Of Services | 13013 |
| Number Of Medicare Beneficiaries | 4330 |
| Total Submitted Charge Amount | 1433532.5 |
| Total Medicare Allowed Amount | 393598.51 |
| Total Medicare Payment Amount | 328211.79 |
| Total Medicare Standardized Payment Amount | 310174.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 5900 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 5827.5 |
| Total Drug Medicare AllowedAmount | 1210.17 |
| Total Drug Medicare PaymentAmount | 948.78 |
| Total Drug Medicare Standardized Payment Amount | 948.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 96 |
| Number Of Medical Services | 7113 |
| Number Of Medicare Beneficiaries With Medical Services | 4330 |
| Total Medical Submitted Charge Amount | 1427705 |
| Total Medical Medicare Allowed Amount | 392388.34 |
| Total Medical Medicare Payment Amount | 327263.01 |
| Total Medical Medicare Standardized Payment Amount | 309225.44 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 861 |
| Number Of Beneficiaries Age 65 to 74 | 1924 |
| Number Of Beneficiaries Age 75 to 84 | 1096 |
| Number Of Beneficiaries Age Greater 84 | 449 |
| Number Of Female Beneficiaries | 3104 |
| Number Of Male Beneficiaries | 1226 |
| Number Of Non Hispanic White Beneficiaries | 3065 |
| Number Of Black or African American Beneficiaries | 214 |
| Number Of AsianPacific Islander Beneficiaries | 187 |
| Number Of Hispanic Beneficiaries | 760 |
| Number Of American Indian Alaska Native Beneficiaries | 29 |
| Number Of Beneficiaries With Race Not Else where Classified | 75 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2929 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1401 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2908 |