| National Provider Identifier [NPI]: | 1558455733 |
| Last Name Of The Provider | WILDER |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1322 ELTON RD |
| Street Address 2 Of The Provider | SUITE H |
| City Of The Provider | JENNINGS |
| Zip Code Of The Provider | 705464100 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 7411 |
| Number Of Medicare Beneficiaries | 885 |
| Total Submitted Charge Amount | 753258 |
| Total Medicare Allowed Amount | 432037.46 |
| Total Medicare Payment Amount | 315024.19 |
| Total Medicare Standardized Payment Amount | 339551.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 1553 |
| Number Of Medicare Beneficiaries With Drug Services | 382 |
| Total Drug Submitted ChargeAmount | 40367 |
| Total Drug Medicare AllowedAmount | 11377.18 |
| Total Drug Medicare PaymentAmount | 9769.77 |
| Total Drug Medicare Standardized Payment Amount | 9769.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 85 |
| Number Of Medical Services | 5858 |
| Number Of Medicare Beneficiaries With Medical Services | 885 |
| Total Medical Submitted Charge Amount | 712891 |
| Total Medical Medicare Allowed Amount | 420660.28 |
| Total Medical Medicare Payment Amount | 305254.42 |
| Total Medical Medicare Standardized Payment Amount | 329781.25 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 97 |
| Number Of Beneficiaries Age 65 to 74 | 322 |
| Number Of Beneficiaries Age 75 to 84 | 285 |
| Number Of Beneficiaries Age Greater 84 | 181 |
| Number Of Female Beneficiaries | 504 |
| Number Of Male Beneficiaries | 381 |
| Number Of Non Hispanic White Beneficiaries | 758 |
| Number Of Black or African American Beneficiaries | 106 |
| 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 | 614 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 271 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.3951 |