| National Provider Identifier [NPI]: | 1124161872 |
| Last Name Of The Provider | WAGNER |
| First Name Of The Provider | LLOYD |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 15031 RINALDI ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MISSION HILLS |
| Zip Code Of The Provider | 913451207 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 1033 |
| Number Of Medicare Beneficiaries | 699 |
| Total Submitted Charge Amount | 125831 |
| Total Medicare Allowed Amount | 27853.88 |
| Total Medicare Payment Amount | 21022.03 |
| Total Medicare Standardized Payment Amount | 19892.49 |
| 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 | 91 |
| Number Of Medical Services | 1033 |
| Number Of Medicare Beneficiaries With Medical Services | 699 |
| Total Medical Submitted Charge Amount | 125831 |
| Total Medical Medicare Allowed Amount | 27853.88 |
| Total Medical Medicare Payment Amount | 21022.03 |
| Total Medical Medicare Standardized Payment Amount | 19892.49 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 149 |
| Number Of Beneficiaries Age 65 to 74 | 201 |
| Number Of Beneficiaries Age 75 to 84 | 222 |
| Number Of Beneficiaries Age Greater 84 | 127 |
| Number Of Female Beneficiaries | 407 |
| Number Of Male Beneficiaries | 292 |
| Number Of Non Hispanic White Beneficiaries | 322 |
| Number Of Black or African American Beneficiaries | 36 |
| Number Of AsianPacific Islander Beneficiaries | 45 |
| Number Of Hispanic Beneficiaries | 280 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 251 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 448 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 56 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 2.8619 |