| National Provider Identifier [NPI]: | 1508824608 |
| Last Name Of The Provider | WILF |
| First Name Of The Provider | LARRY |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5742 BOOTH RD |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322075982 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 2735 |
| Number Of Medicare Beneficiaries | 1066 |
| Total Submitted Charge Amount | 9295489.45 |
| Total Medicare Allowed Amount | 1603476.92 |
| Total Medicare Payment Amount | 1241902.06 |
| Total Medicare Standardized Payment Amount | 1256742.55 |
| 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 | 2735 |
| Number Of Medicare Beneficiaries With Medical Services | 1066 |
| Total Medical Submitted Charge Amount | 9295489.45 |
| Total Medical Medicare Allowed Amount | 1603476.92 |
| Total Medical Medicare Payment Amount | 1241902.06 |
| Total Medical Medicare Standardized Payment Amount | 1256742.55 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 104 |
| Number Of Beneficiaries Age 65 to 74 | 499 |
| Number Of Beneficiaries Age 75 to 84 | 366 |
| Number Of Beneficiaries Age Greater 84 | 97 |
| Number Of Female Beneficiaries | 482 |
| Number Of Male Beneficiaries | 584 |
| Number Of Non Hispanic White Beneficiaries | 923 |
| Number Of Black or African American Beneficiaries | 84 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 903 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 163 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 60 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.7662 |