| National Provider Identifier [NPI]: | 1578515128 |
| Last Name Of The Provider | WETHERLY |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3950 AUSTELL RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUSTELL |
| Zip Code Of The Provider | 301061121 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 150 |
| Number Of Services | 5864 |
| Number Of Medicare Beneficiaries | 4263 |
| Total Submitted Charge Amount | 689593 |
| Total Medicare Allowed Amount | 143664.89 |
| Total Medicare Payment Amount | 110665.14 |
| Total Medicare Standardized Payment Amount | 111963.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 150 |
| Number Of Medical Services | 5864 |
| Number Of Medicare Beneficiaries With Medical Services | 4263 |
| Total Medical Submitted Charge Amount | 689593 |
| Total Medical Medicare Allowed Amount | 143664.89 |
| Total Medical Medicare Payment Amount | 110665.14 |
| Total Medical Medicare Standardized Payment Amount | 111963.3 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 788 |
| Number Of Beneficiaries Age 65 to 74 | 1617 |
| Number Of Beneficiaries Age 75 to 84 | 1229 |
| Number Of Beneficiaries Age Greater 84 | 629 |
| Number Of Female Beneficiaries | 2536 |
| Number Of Male Beneficiaries | 1727 |
| Number Of Non Hispanic White Beneficiaries | 3377 |
| Number Of Black or African American Beneficiaries | 705 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 102 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3325 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 938 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.9349 |