| National Provider Identifier [NPI]: | 1528063880 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 855 N WESTHAVEN DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | OSHKOSH |
| Zip Code Of The Provider | 549047668 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 2313 |
| Number Of Medicare Beneficiaries | 842 |
| Total Submitted Charge Amount | 738139.05 |
| Total Medicare Allowed Amount | 135524.9 |
| Total Medicare Payment Amount | 100114.72 |
| Total Medicare Standardized Payment Amount | 106629.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 27 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 1798.05 |
| Total Drug Medicare AllowedAmount | 1042.56 |
| Total Drug Medicare PaymentAmount | 1021.64 |
| Total Drug Medicare Standardized Payment Amount | 1021.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 2286 |
| Number Of Medicare Beneficiaries With Medical Services | 842 |
| Total Medical Submitted Charge Amount | 736341 |
| Total Medical Medicare Allowed Amount | 134482.34 |
| Total Medical Medicare Payment Amount | 99093.08 |
| Total Medical Medicare Standardized Payment Amount | 105608.17 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 182 |
| Number Of Beneficiaries Age 65 to 74 | 321 |
| Number Of Beneficiaries Age 75 to 84 | 253 |
| Number Of Beneficiaries Age Greater 84 | 86 |
| Number Of Female Beneficiaries | 421 |
| Number Of Male Beneficiaries | 421 |
| Number Of Non Hispanic White Beneficiaries | 814 |
| 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 | 653 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 189 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 23 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 48 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.6066 |