| National Provider Identifier [NPI]: | 1235171745 |
| Last Name Of The Provider | WESSELL |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 SAN PABLO RD S |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322241865 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 143 |
| Number Of Services | 25417 |
| Number Of Medicare Beneficiaries | 4819 |
| Total Submitted Charge Amount | 486591.33 |
| Total Medicare Allowed Amount | 346319.2 |
| Total Medicare Payment Amount | 258407.81 |
| Total Medicare Standardized Payment Amount | 288826.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 17715 |
| Number Of Medicare Beneficiaries With Drug Services | 141 |
| Total Drug Submitted ChargeAmount | 7017.76 |
| Total Drug Medicare AllowedAmount | 4902.43 |
| Total Drug Medicare PaymentAmount | 3519.4 |
| Total Drug Medicare Standardized Payment Amount | 3519.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 136 |
| Number Of Medical Services | 7702 |
| Number Of Medicare Beneficiaries With Medical Services | 4811 |
| Total Medical Submitted Charge Amount | 479573.57 |
| Total Medical Medicare Allowed Amount | 341416.77 |
| Total Medical Medicare Payment Amount | 254888.41 |
| Total Medical Medicare Standardized Payment Amount | 285307.55 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 620 |
| Number Of Beneficiaries Age 65 to 74 | 2028 |
| Number Of Beneficiaries Age 75 to 84 | 1524 |
| Number Of Beneficiaries Age Greater 84 | 647 |
| Number Of Female Beneficiaries | 2762 |
| Number Of Male Beneficiaries | 2057 |
| Number Of Non Hispanic White Beneficiaries | 4235 |
| Number Of Black or African American Beneficiaries | 321 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 124 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 69 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4482 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 337 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5354 |