| National Provider Identifier [NPI]: | 1013982610 |
| Last Name Of The Provider | WONG |
| First Name Of The Provider | HUMPHREY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1801 E 54TH ST |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | DAVENPORT |
| Zip Code Of The Provider | 528077209 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 4587 |
| Number Of Medicare Beneficiaries | 1293 |
| Total Submitted Charge Amount | 638260 |
| Total Medicare Allowed Amount | 322750.2 |
| Total Medicare Payment Amount | 245179.53 |
| Total Medicare Standardized Payment Amount | 245412.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 42 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 2780 |
| Total Drug Medicare AllowedAmount | 2123 |
| Total Drug Medicare PaymentAmount | 2063.99 |
| Total Drug Medicare Standardized Payment Amount | 2063.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 4545 |
| Number Of Medicare Beneficiaries With Medical Services | 1293 |
| Total Medical Submitted Charge Amount | 635480 |
| Total Medical Medicare Allowed Amount | 320627.2 |
| Total Medical Medicare Payment Amount | 243115.54 |
| Total Medical Medicare Standardized Payment Amount | 243348.15 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 171 |
| Number Of Beneficiaries Age 65 to 74 | 476 |
| Number Of Beneficiaries Age 75 to 84 | 460 |
| Number Of Beneficiaries Age Greater 84 | 186 |
| Number Of Female Beneficiaries | 677 |
| Number Of Male Beneficiaries | 616 |
| Number Of Non Hispanic White Beneficiaries | 1211 |
| Number Of Black or African American Beneficiaries | 47 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1083 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 210 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 58 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.8138 |