| National Provider Identifier [NPI]: | 1174765895 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4504 BOAT CLUB RD |
| Street Address 2 Of The Provider | STE.800 |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 761357003 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 6384 |
| Number Of Medicare Beneficiaries | 1105 |
| Total Submitted Charge Amount | 623336.43 |
| Total Medicare Allowed Amount | 250496.13 |
| Total Medicare Payment Amount | 179832.43 |
| Total Medicare Standardized Payment Amount | 221016.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 321 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 3871.15 |
| Total Drug Medicare AllowedAmount | 831.41 |
| Total Drug Medicare PaymentAmount | 596.31 |
| Total Drug Medicare Standardized Payment Amount | 596.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 6063 |
| Number Of Medicare Beneficiaries With Medical Services | 1105 |
| Total Medical Submitted Charge Amount | 619465.28 |
| Total Medical Medicare Allowed Amount | 249664.72 |
| Total Medical Medicare Payment Amount | 179236.12 |
| Total Medical Medicare Standardized Payment Amount | 220420.37 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 500 |
| Number Of Beneficiaries Age 75 to 84 | 422 |
| Number Of Beneficiaries Age Greater 84 | 138 |
| Number Of Female Beneficiaries | 570 |
| Number Of Male Beneficiaries | 535 |
| Number Of Non Hispanic White Beneficiaries | 1078 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 1037 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9818 |