| National Provider Identifier [NPI]: | 1134175821 |
| Last Name Of The Provider | WIRTH |
| First Name Of The Provider | DONALD |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2116 W FAIDLEY AVE |
| Street Address 2 Of The Provider | STE 400 |
| City Of The Provider | GRAND ISLAND |
| Zip Code Of The Provider | 688034671 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 117 |
| Number Of Services | 3226 |
| Number Of Medicare Beneficiaries | 577 |
| Total Submitted Charge Amount | 238116 |
| Total Medicare Allowed Amount | 135361.11 |
| Total Medicare Payment Amount | 98805.58 |
| Total Medicare Standardized Payment Amount | 105918.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 231 |
| Number Of Medicare Beneficiaries With Drug Services | 89 |
| Total Drug Submitted ChargeAmount | 11000 |
| Total Drug Medicare AllowedAmount | 7594.37 |
| Total Drug Medicare PaymentAmount | 7235.11 |
| Total Drug Medicare Standardized Payment Amount | 7235.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 105 |
| Number Of Medical Services | 2995 |
| Number Of Medicare Beneficiaries With Medical Services | 577 |
| Total Medical Submitted Charge Amount | 227116 |
| Total Medical Medicare Allowed Amount | 127766.74 |
| Total Medical Medicare Payment Amount | 91570.47 |
| Total Medical Medicare Standardized Payment Amount | 98683.44 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 127 |
| Number Of Beneficiaries Age 65 to 74 | 219 |
| Number Of Beneficiaries Age 75 to 84 | 146 |
| Number Of Beneficiaries Age Greater 84 | 85 |
| Number Of Female Beneficiaries | 320 |
| Number Of Male Beneficiaries | 257 |
| Number Of Non Hispanic White Beneficiaries | 525 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 391 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 186 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3577 |