| National Provider Identifier [NPI]: | 1407850365 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | CARLENE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6038 W NORDLING LOOP |
| Street Address 2 Of The Provider | |
| City Of The Provider | CRYSTAL RIVER |
| Zip Code Of The Provider | 34429 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 6390 |
| Number Of Medicare Beneficiaries | 860 |
| Total Submitted Charge Amount | 460581.02 |
| Total Medicare Allowed Amount | 365619.7 |
| Total Medicare Payment Amount | 260679.54 |
| Total Medicare Standardized Payment Amount | 263453.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 19 |
| Number Of Drug Services | 728 |
| Number Of Medicare Beneficiaries With Drug Services | 349 |
| Total Drug Submitted ChargeAmount | 16005.37 |
| Total Drug Medicare AllowedAmount | 11479.9 |
| Total Drug Medicare PaymentAmount | 11160.99 |
| Total Drug Medicare Standardized Payment Amount | 11160.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 5662 |
| Number Of Medicare Beneficiaries With Medical Services | 860 |
| Total Medical Submitted Charge Amount | 444575.65 |
| Total Medical Medicare Allowed Amount | 354139.8 |
| Total Medical Medicare Payment Amount | 249518.55 |
| Total Medical Medicare Standardized Payment Amount | 252292.56 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 97 |
| Number Of Beneficiaries Age 65 to 74 | 454 |
| Number Of Beneficiaries Age 75 to 84 | 251 |
| Number Of Beneficiaries Age Greater 84 | 58 |
| Number Of Female Beneficiaries | 590 |
| Number Of Male Beneficiaries | 270 |
| Number Of Non Hispanic White Beneficiaries | 817 |
| Number Of Black or African American Beneficiaries | 21 |
| 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 | 778 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 82 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9993 |