| National Provider Identifier [NPI]: | 1982698155 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 408 N ROANE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | HARRIMAN |
| Zip Code Of The Provider | 377482057 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 3013 |
| Number Of Medicare Beneficiaries | 392 |
| Total Submitted Charge Amount | 228885 |
| Total Medicare Allowed Amount | 113979.52 |
| Total Medicare Payment Amount | 84685.89 |
| Total Medicare Standardized Payment Amount | 91219.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 309 |
| Number Of Medicare Beneficiaries With Drug Services | 156 |
| Total Drug Submitted ChargeAmount | 12473 |
| Total Drug Medicare AllowedAmount | 6061 |
| Total Drug Medicare PaymentAmount | 5777.57 |
| Total Drug Medicare Standardized Payment Amount | 5777.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 2704 |
| Number Of Medicare Beneficiaries With Medical Services | 392 |
| Total Medical Submitted Charge Amount | 216412 |
| Total Medical Medicare Allowed Amount | 107918.52 |
| Total Medical Medicare Payment Amount | 78908.32 |
| Total Medical Medicare Standardized Payment Amount | 85441.89 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 156 |
| Number Of Beneficiaries Age 75 to 84 | 117 |
| Number Of Beneficiaries Age Greater 84 | 60 |
| Number Of Female Beneficiaries | 200 |
| Number Of Male Beneficiaries | 192 |
| Number Of Non Hispanic White Beneficiaries | 378 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 334 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 58 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2884 |