| National Provider Identifier [NPI]: | 1275584997 |
| Last Name Of The Provider | WEGNER |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 949 N CURTIS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOISE |
| Zip Code Of The Provider | 837061307 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 199 |
| Number Of Services | 5014 |
| Number Of Medicare Beneficiaries | 2272 |
| Total Submitted Charge Amount | 352865.62 |
| Total Medicare Allowed Amount | 124556.91 |
| Total Medicare Payment Amount | 90749.09 |
| Total Medicare Standardized Payment Amount | 97508.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1808 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 328.4 |
| Total Drug Medicare AllowedAmount | 323.02 |
| Total Drug Medicare PaymentAmount | 237.07 |
| Total Drug Medicare Standardized Payment Amount | 237.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 196 |
| Number Of Medical Services | 3206 |
| Number Of Medicare Beneficiaries With Medical Services | 2272 |
| Total Medical Submitted Charge Amount | 352537.22 |
| Total Medical Medicare Allowed Amount | 124233.89 |
| Total Medical Medicare Payment Amount | 90512.02 |
| Total Medical Medicare Standardized Payment Amount | 97271.26 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 511 |
| Number Of Beneficiaries Age 65 to 74 | 753 |
| Number Of Beneficiaries Age 75 to 84 | 628 |
| Number Of Beneficiaries Age Greater 84 | 380 |
| Number Of Female Beneficiaries | 1259 |
| Number Of Male Beneficiaries | 1013 |
| Number Of Non Hispanic White Beneficiaries | 2025 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| Number Of Hispanic Beneficiaries | 172 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1485 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 787 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.6587 |