National Provider Identifier [NPI]: |
1548244247 |
Last Name Of The Provider |
WILSON |
First Name Of The Provider |
MATTHEW |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
8700 BEVERLY BLVD. |
Street Address 2 Of The Provider |
|
City Of The Provider |
LOS ANGELES |
Zip Code Of The Provider |
900481865 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
General Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
57 |
Number Of Services |
314 |
Number Of Medicare Beneficiaries |
183 |
Total Submitted Charge Amount |
154735 |
Total Medicare Allowed Amount |
61828.84 |
Total Medicare Payment Amount |
47991.21 |
Total Medicare Standardized Payment Amount |
47523.78 |
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 |
57 |
Number Of Medical Services |
314 |
Number Of Medicare Beneficiaries With Medical Services |
183 |
Total Medical Submitted Charge Amount |
154735 |
Total Medical Medicare Allowed Amount |
61828.84 |
Total Medical Medicare Payment Amount |
47991.21 |
Total Medical Medicare Standardized Payment Amount |
47523.78 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
30 |
Number Of Beneficiaries Age 65 to 74 |
74 |
Number Of Beneficiaries Age 75 to 84 |
53 |
Number Of Beneficiaries Age Greater 84 |
26 |
Number Of Female Beneficiaries |
99 |
Number Of Male Beneficiaries |
84 |
Number Of Non Hispanic White Beneficiaries |
109 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
58 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
98 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
85 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
16 |
Percent Of With Asthma |
17 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
45 |
Percent Of With Chronic Kidney Disease |
47 |
Percent Of With Chronic Obstructive Pulmonary Disease |
27 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
51 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
56 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
2.2693 |