National Provider Identifier [NPI]: |
1699740365 |
Last Name Of The Provider |
WILSON |
First Name Of The Provider |
BRITT |
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 |
705 DIXIE ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
CARROLLTON |
Zip Code Of The Provider |
301173818 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
114 |
Number Of Services |
2808 |
Number Of Medicare Beneficiaries |
1712 |
Total Submitted Charge Amount |
278131 |
Total Medicare Allowed Amount |
66206.3 |
Total Medicare Payment Amount |
51597.8 |
Total Medicare Standardized Payment Amount |
54216.76 |
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 |
114 |
Number Of Medical Services |
2808 |
Number Of Medicare Beneficiaries With Medical Services |
1712 |
Total Medical Submitted Charge Amount |
278131 |
Total Medical Medicare Allowed Amount |
66206.3 |
Total Medical Medicare Payment Amount |
51597.8 |
Total Medical Medicare Standardized Payment Amount |
54216.76 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
356 |
Number Of Beneficiaries Age 65 to 74 |
724 |
Number Of Beneficiaries Age 75 to 84 |
466 |
Number Of Beneficiaries Age Greater 84 |
166 |
Number Of Female Beneficiaries |
1200 |
Number Of Male Beneficiaries |
512 |
Number Of Non Hispanic White Beneficiaries |
1482 |
Number Of Black or African American Beneficiaries |
191 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
27 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
1218 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
494 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
23 |
Percent Of With Chronic Kidney Disease |
33 |
Percent Of With Chronic Obstructive Pulmonary Disease |
24 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
67 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
43 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.5254 |