| National Provider Identifier [NPI]: | 1134100589 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | RICHARD |
| 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 | 5 MOBILE INFIRMARY CIR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOBILE |
| Zip Code Of The Provider | 366073513 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 224 |
| Number Of Services | 6385 |
| Number Of Medicare Beneficiaries | 4078 |
| Total Submitted Charge Amount | 595292 |
| Total Medicare Allowed Amount | 193815.84 |
| Total Medicare Payment Amount | 148903.12 |
| Total Medicare Standardized Payment Amount | 159722.25 |
| 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 | 224 |
| Number Of Medical Services | 6385 |
| Number Of Medicare Beneficiaries With Medical Services | 4078 |
| Total Medical Submitted Charge Amount | 595292 |
| Total Medical Medicare Allowed Amount | 193815.84 |
| Total Medical Medicare Payment Amount | 148903.12 |
| Total Medical Medicare Standardized Payment Amount | 159722.25 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 787 |
| Number Of Beneficiaries Age 65 to 74 | 1543 |
| Number Of Beneficiaries Age 75 to 84 | 1214 |
| Number Of Beneficiaries Age Greater 84 | 534 |
| Number Of Female Beneficiaries | 2585 |
| Number Of Male Beneficiaries | 1493 |
| Number Of Non Hispanic White Beneficiaries | 2824 |
| Number Of Black or African American Beneficiaries | 1191 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3146 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 932 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.7022 |