| National Provider Identifier [NPI]: | 1174513915 |
| Last Name Of The Provider | WILDER |
| First Name Of The Provider | DEBRA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 97 LAKESHORE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | KUTTAWA |
| Zip Code Of The Provider | 420556202 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 4255 |
| Number Of Medicare Beneficiaries | 840 |
| Total Submitted Charge Amount | 409302 |
| Total Medicare Allowed Amount | 188806.48 |
| Total Medicare Payment Amount | 126440.57 |
| Total Medicare Standardized Payment Amount | 135834.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 1062 |
| Number Of Medicare Beneficiaries With Drug Services | 210 |
| Total Drug Submitted ChargeAmount | 19847 |
| Total Drug Medicare AllowedAmount | 3176.88 |
| Total Drug Medicare PaymentAmount | 2368.83 |
| Total Drug Medicare Standardized Payment Amount | 2368.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 91 |
| Number Of Medical Services | 3193 |
| Number Of Medicare Beneficiaries With Medical Services | 840 |
| Total Medical Submitted Charge Amount | 389455 |
| Total Medical Medicare Allowed Amount | 185629.6 |
| Total Medical Medicare Payment Amount | 124071.74 |
| Total Medical Medicare Standardized Payment Amount | 133465.9 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 227 |
| Number Of Beneficiaries Age 65 to 74 | 318 |
| Number Of Beneficiaries Age 75 to 84 | 197 |
| Number Of Beneficiaries Age Greater 84 | 98 |
| Number Of Female Beneficiaries | 511 |
| Number Of Male Beneficiaries | 329 |
| Number Of Non Hispanic White Beneficiaries | 802 |
| Number Of Black or African American Beneficiaries | |
| 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 | 535 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 305 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1772 |