| National Provider Identifier [NPI]: | 1740261817 |
| Last Name Of The Provider | WAGNER |
| First Name Of The Provider | KATHRYNE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 LILLY RD NE |
| Street Address 2 Of The Provider | SUITE 204 |
| City Of The Provider | OLYMPIA |
| Zip Code Of The Provider | 985065195 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Gastroenterology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 847 |
| Number Of Medicare Beneficiaries | 382 |
| Total Submitted Charge Amount | 368270.45 |
| Total Medicare Allowed Amount | 94201.64 |
| Total Medicare Payment Amount | 68818.47 |
| Total Medicare Standardized Payment Amount | 69130.75 |
| 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 | 37 |
| Number Of Medical Services | 847 |
| Number Of Medicare Beneficiaries With Medical Services | 382 |
| Total Medical Submitted Charge Amount | 368270.45 |
| Total Medical Medicare Allowed Amount | 94201.64 |
| Total Medical Medicare Payment Amount | 68818.47 |
| Total Medical Medicare Standardized Payment Amount | 69130.75 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 191 |
| Number Of Beneficiaries Age 75 to 84 | 108 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 286 |
| Number Of Male Beneficiaries | 96 |
| Number Of Non Hispanic White Beneficiaries | 353 |
| 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 | 333 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0356 |