| National Provider Identifier [NPI]: | 1437121134 |
| Last Name Of The Provider | WICHMAN |
| First Name Of The Provider | NEVILLE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2500 NORTH STATE ST. |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 39216 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 160 |
| Number Of Services | 9700 |
| Number Of Medicare Beneficiaries | 5327 |
| Total Submitted Charge Amount | 1469966.5 |
| Total Medicare Allowed Amount | 261274.97 |
| Total Medicare Payment Amount | 192472.55 |
| Total Medicare Standardized Payment Amount | 209434.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 527 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 2635 |
| Total Drug Medicare AllowedAmount | 1038.27 |
| Total Drug Medicare PaymentAmount | 800.63 |
| Total Drug Medicare Standardized Payment Amount | 800.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 159 |
| Number Of Medical Services | 9173 |
| Number Of Medicare Beneficiaries With Medical Services | 5326 |
| Total Medical Submitted Charge Amount | 1467331.5 |
| Total Medical Medicare Allowed Amount | 260236.7 |
| Total Medical Medicare Payment Amount | 191671.92 |
| Total Medical Medicare Standardized Payment Amount | 208633.7 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1384 |
| Number Of Beneficiaries Age 65 to 74 | 1777 |
| Number Of Beneficiaries Age 75 to 84 | 1419 |
| Number Of Beneficiaries Age Greater 84 | 747 |
| Number Of Female Beneficiaries | 3197 |
| Number Of Male Beneficiaries | 2130 |
| Number Of Non Hispanic White Beneficiaries | 3529 |
| Number Of Black or African American Beneficiaries | 1718 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 50 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3147 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2180 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6238 |