| National Provider Identifier [NPI]: | 1821252776 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | GROVER |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2587 WILLOW POINT WAY |
| Street Address 2 Of The Provider | STE 1 |
| City Of The Provider | KNOXVILLE |
| Zip Code Of The Provider | 379313162 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 318 |
| Number Of Medicare Beneficiaries | 47 |
| Total Submitted Charge Amount | 39320 |
| Total Medicare Allowed Amount | 18742.85 |
| Total Medicare Payment Amount | 12545.18 |
| Total Medicare Standardized Payment Amount | 15176.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 510 |
| Total Drug Medicare AllowedAmount | 153.8 |
| Total Drug Medicare PaymentAmount | 136.38 |
| Total Drug Medicare Standardized Payment Amount | 136.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 290 |
| Number Of Medicare Beneficiaries With Medical Services | 47 |
| Total Medical Submitted Charge Amount | 38810 |
| Total Medical Medicare Allowed Amount | 18589.05 |
| Total Medical Medicare Payment Amount | 12408.8 |
| Total Medical Medicare Standardized Payment Amount | 15040.4 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 19 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 23 |
| Number Of Male Beneficiaries | 24 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 23 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2451 |