| National Provider Identifier [NPI]: | 1518917830 |
| Last Name Of The Provider | WAGGENER |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 ABRAHAM FLEXNER WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 402021818 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 168 |
| Number Of Services | 7768 |
| Number Of Medicare Beneficiaries | 3981 |
| Total Submitted Charge Amount | 693869 |
| Total Medicare Allowed Amount | 188495.26 |
| Total Medicare Payment Amount | 144491.05 |
| Total Medicare Standardized Payment Amount | 152653.78 |
| 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 | 168 |
| Number Of Medical Services | 7768 |
| Number Of Medicare Beneficiaries With Medical Services | 3981 |
| Total Medical Submitted Charge Amount | 693869 |
| Total Medical Medicare Allowed Amount | 188495.26 |
| Total Medical Medicare Payment Amount | 144491.05 |
| Total Medical Medicare Standardized Payment Amount | 152653.78 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1028 |
| Number Of Beneficiaries Age 65 to 74 | 1395 |
| Number Of Beneficiaries Age 75 to 84 | 1053 |
| Number Of Beneficiaries Age Greater 84 | 505 |
| Number Of Female Beneficiaries | 2432 |
| Number Of Male Beneficiaries | 1549 |
| Number Of Non Hispanic White Beneficiaries | 3483 |
| Number Of Black or African American Beneficiaries | 411 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2751 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1230 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.7729 |