| National Provider Identifier [NPI]: | 1336130087 |
| Last Name Of The Provider | WAGNER |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2740 M ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MERCED |
| Zip Code Of The Provider | 953402813 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 204 |
| Number Of Services | 5486 |
| Number Of Medicare Beneficiaries | 2923 |
| Total Submitted Charge Amount | 369791 |
| Total Medicare Allowed Amount | 141686.85 |
| Total Medicare Payment Amount | 106124.73 |
| Total Medicare Standardized Payment Amount | 105053.2 |
| 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 | 204 |
| Number Of Medical Services | 5486 |
| Number Of Medicare Beneficiaries With Medical Services | 2923 |
| Total Medical Submitted Charge Amount | 369791 |
| Total Medical Medicare Allowed Amount | 141686.85 |
| Total Medical Medicare Payment Amount | 106124.73 |
| Total Medical Medicare Standardized Payment Amount | 105053.2 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 542 |
| Number Of Beneficiaries Age 65 to 74 | 1071 |
| Number Of Beneficiaries Age 75 to 84 | 863 |
| Number Of Beneficiaries Age Greater 84 | 447 |
| Number Of Female Beneficiaries | 1871 |
| Number Of Male Beneficiaries | 1052 |
| Number Of Non Hispanic White Beneficiaries | 1837 |
| Number Of Black or African American Beneficiaries | 166 |
| Number Of AsianPacific Islander Beneficiaries | 123 |
| Number Of Hispanic Beneficiaries | 751 |
| Number Of American Indian Alaska Native Beneficiaries | 16 |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1656 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1267 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7666 |