| National Provider Identifier [NPI]: | 1659592152 |
| Last Name Of The Provider | WILDES |
| First Name Of The Provider | TANYA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 150 ENTRANCE WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT PETERS |
| Zip Code Of The Provider | 633761645 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Medical Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 24977 |
| Number Of Medicare Beneficiaries | 239 |
| Total Submitted Charge Amount | 1476832 |
| Total Medicare Allowed Amount | 492040.39 |
| Total Medicare Payment Amount | 377127.78 |
| Total Medicare Standardized Payment Amount | 376907.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 56 |
| Number Of Drug Services | 23827 |
| Number Of Medicare Beneficiaries With Drug Services | 123 |
| Total Drug Submitted ChargeAmount | 1233163 |
| Total Drug Medicare AllowedAmount | 406995.44 |
| Total Drug Medicare PaymentAmount | 312263.55 |
| Total Drug Medicare Standardized Payment Amount | 312263.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 1150 |
| Number Of Medicare Beneficiaries With Medical Services | 239 |
| Total Medical Submitted Charge Amount | 243669 |
| Total Medical Medicare Allowed Amount | 85044.95 |
| Total Medical Medicare Payment Amount | 64864.23 |
| Total Medical Medicare Standardized Payment Amount | 64643.96 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 121 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 104 |
| Number Of Male Beneficiaries | 135 |
| Number Of Non Hispanic White Beneficiaries | 211 |
| 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 | 211 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 49 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 2.274 |