| National Provider Identifier [NPI]: | 1821052747 |
| Last Name Of The Provider | WAGNER-REISS |
| First Name Of The Provider | KATHERINE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2800 MAIN ST |
| Street Address 2 Of The Provider | ST. VINCENT'S MEDICAL CENTER, DEPT. OF PATHOLOGY |
| City Of The Provider | BRIDGEPORT |
| Zip Code Of The Provider | 066064201 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 3753 |
| Number Of Medicare Beneficiaries | 1282 |
| Total Submitted Charge Amount | 630901.08 |
| Total Medicare Allowed Amount | 237828.01 |
| Total Medicare Payment Amount | 184013.43 |
| Total Medicare Standardized Payment Amount | 122529.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 3753 |
| Number Of Medicare Beneficiaries With Medical Services | 1282 |
| Total Medical Submitted Charge Amount | 630901.08 |
| Total Medical Medicare Allowed Amount | 237828.01 |
| Total Medical Medicare Payment Amount | 184013.43 |
| Total Medical Medicare Standardized Payment Amount | 122529.17 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 115 |
| Number Of Beneficiaries Age 65 to 74 | 590 |
| Number Of Beneficiaries Age 75 to 84 | 414 |
| Number Of Beneficiaries Age Greater 84 | 163 |
| Number Of Female Beneficiaries | 738 |
| Number Of Male Beneficiaries | 544 |
| Number Of Non Hispanic White Beneficiaries | 1033 |
| Number Of Black or African American Beneficiaries | 107 |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| Number Of Hispanic Beneficiaries | 99 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 980 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 302 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3397 |