| National Provider Identifier [NPI]: | 1699852814 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | KIMBERLEY |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2001 PEACHTREE RD |
| Street Address 2 Of The Provider | SUITE 205 |
| City Of The Provider | ATLANTA |
| Zip Code Of The Provider | 303091476 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 5439 |
| Number Of Medicare Beneficiaries | 385 |
| Total Submitted Charge Amount | 534872.25 |
| Total Medicare Allowed Amount | 239338.65 |
| Total Medicare Payment Amount | 167119.87 |
| Total Medicare Standardized Payment Amount | 169279.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 4079 |
| Number Of Medicare Beneficiaries With Drug Services | 193 |
| Total Drug Submitted ChargeAmount | 334381.29 |
| Total Drug Medicare AllowedAmount | 119712.32 |
| Total Drug Medicare PaymentAmount | 80418.68 |
| Total Drug Medicare Standardized Payment Amount | 80418.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 1360 |
| Number Of Medicare Beneficiaries With Medical Services | 385 |
| Total Medical Submitted Charge Amount | 200490.96 |
| Total Medical Medicare Allowed Amount | 119626.33 |
| Total Medical Medicare Payment Amount | 86701.19 |
| Total Medical Medicare Standardized Payment Amount | 88860.46 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 108 |
| Number Of Beneficiaries Age 65 to 74 | 191 |
| Number Of Beneficiaries Age 75 to 84 | 72 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 318 |
| Number Of Male Beneficiaries | 67 |
| Number Of Non Hispanic White Beneficiaries | 327 |
| Number Of Black or African American Beneficiaries | 40 |
| 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 | 363 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 69 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.169 |