| National Provider Identifier [NPI]: | 1194781278 |
| Last Name Of The Provider | WAHL |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 303 NICOLLET BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BURNSVILLE |
| Zip Code Of The Provider | 55337 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 69 |
| Number Of Services | 1748 |
| Number Of Medicare Beneficiaries | 553 |
| Total Submitted Charge Amount | 209576.22 |
| Total Medicare Allowed Amount | 77339.58 |
| Total Medicare Payment Amount | 59052.79 |
| Total Medicare Standardized Payment Amount | 60442.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 97 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 2004.22 |
| Total Drug Medicare AllowedAmount | 1780.18 |
| Total Drug Medicare PaymentAmount | 1719.55 |
| Total Drug Medicare Standardized Payment Amount | 1719.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 1651 |
| Number Of Medicare Beneficiaries With Medical Services | 553 |
| Total Medical Submitted Charge Amount | 207572 |
| Total Medical Medicare Allowed Amount | 75559.4 |
| Total Medical Medicare Payment Amount | 57333.24 |
| Total Medical Medicare Standardized Payment Amount | 58723.11 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 240 |
| Number Of Beneficiaries Age 75 to 84 | 187 |
| Number Of Beneficiaries Age Greater 84 | 71 |
| Number Of Female Beneficiaries | 495 |
| Number Of Male Beneficiaries | 58 |
| Number Of Non Hispanic White Beneficiaries | 514 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| 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 | 491 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.994 |