| National Provider Identifier [NPI]: | 1992715296 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3300 HIGH ST |
| Street Address 2 Of The Provider | SUITE 6 |
| City Of The Provider | PORTSMOUTH |
| Zip Code Of The Provider | 237073321 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 6986 |
| Number Of Medicare Beneficiaries | 674 |
| Total Submitted Charge Amount | 225770.65 |
| Total Medicare Allowed Amount | 217504 |
| Total Medicare Payment Amount | 161457.3 |
| Total Medicare Standardized Payment Amount | 167118.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 349 |
| Number Of Medicare Beneficiaries With Drug Services | 310 |
| Total Drug Submitted ChargeAmount | 8333.01 |
| Total Drug Medicare AllowedAmount | 8239.3 |
| Total Drug Medicare PaymentAmount | 8035.08 |
| Total Drug Medicare Standardized Payment Amount | 8035.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 6637 |
| Number Of Medicare Beneficiaries With Medical Services | 674 |
| Total Medical Submitted Charge Amount | 217437.64 |
| Total Medical Medicare Allowed Amount | 209264.7 |
| Total Medical Medicare Payment Amount | 153422.22 |
| Total Medical Medicare Standardized Payment Amount | 159083.42 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 290 |
| Number Of Beneficiaries Age 75 to 84 | 182 |
| Number Of Beneficiaries Age Greater 84 | 159 |
| Number Of Female Beneficiaries | 398 |
| Number Of Male Beneficiaries | 276 |
| Number Of Non Hispanic White Beneficiaries | 601 |
| Number Of Black or African American Beneficiaries | 61 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 659 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0635 |