| National Provider Identifier [NPI]: | 1528043536 |
| Last Name Of The Provider | WAGNER |
| First Name Of The Provider | JOHN |
| 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 | 5149 N 9TH AVE |
| Street Address 2 Of The Provider | SUITE 120 |
| City Of The Provider | PENSACOLA |
| Zip Code Of The Provider | 325048734 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 2651 |
| Number Of Medicare Beneficiaries | 702 |
| Total Submitted Charge Amount | 428967 |
| Total Medicare Allowed Amount | 310719.85 |
| Total Medicare Payment Amount | 234194.47 |
| Total Medicare Standardized Payment Amount | 235441.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 771 |
| Total Drug Medicare AllowedAmount | 631.11 |
| Total Drug Medicare PaymentAmount | 616.68 |
| Total Drug Medicare Standardized Payment Amount | 616.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 2619 |
| Number Of Medicare Beneficiaries With Medical Services | 702 |
| Total Medical Submitted Charge Amount | 428196 |
| Total Medical Medicare Allowed Amount | 310088.74 |
| Total Medical Medicare Payment Amount | 233577.79 |
| Total Medical Medicare Standardized Payment Amount | 234824.64 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 135 |
| Number Of Beneficiaries Age 65 to 74 | 232 |
| Number Of Beneficiaries Age 75 to 84 | 248 |
| Number Of Beneficiaries Age Greater 84 | 87 |
| Number Of Female Beneficiaries | 378 |
| Number Of Male Beneficiaries | 324 |
| Number Of Non Hispanic White Beneficiaries | 579 |
| Number Of Black or African American Beneficiaries | 102 |
| 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 | 505 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 197 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 57 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.1817 |