| National Provider Identifier [NPI]: | 1851568869 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | CHARITY |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2336 DAWSON RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ALBANY |
| Zip Code Of The Provider | 317072800 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 110 |
| Number Of Services | 2264 |
| Number Of Medicare Beneficiaries | 294 |
| Total Submitted Charge Amount | 220224.49 |
| Total Medicare Allowed Amount | 88724.9 |
| Total Medicare Payment Amount | 63591.09 |
| Total Medicare Standardized Payment Amount | 70320.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 127 |
| Number Of Medicare Beneficiaries With Drug Services | 85 |
| Total Drug Submitted ChargeAmount | 7057 |
| Total Drug Medicare AllowedAmount | 2593.65 |
| Total Drug Medicare PaymentAmount | 2303.98 |
| Total Drug Medicare Standardized Payment Amount | 2303.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 102 |
| Number Of Medical Services | 2137 |
| Number Of Medicare Beneficiaries With Medical Services | 294 |
| Total Medical Submitted Charge Amount | 213167.49 |
| Total Medical Medicare Allowed Amount | 86131.25 |
| Total Medical Medicare Payment Amount | 61287.11 |
| Total Medical Medicare Standardized Payment Amount | 68016.64 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 171 |
| Number Of Beneficiaries Age 75 to 84 | 70 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 237 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | 246 |
| Number Of Black or African American Beneficiaries | 48 |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 263 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8464 |