| National Provider Identifier [NPI]: | 1780602136 |
| Last Name Of The Provider | WAGENBERG |
| First Name Of The Provider | SANFORD |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11800 E TWELVE MILE ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WARREN |
| Zip Code Of The Provider | 48093 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 174 |
| Number Of Services | 5847 |
| Number Of Medicare Beneficiaries | 3601 |
| Total Submitted Charge Amount | 406261.42 |
| Total Medicare Allowed Amount | 194854.85 |
| Total Medicare Payment Amount | 151094.57 |
| Total Medicare Standardized Payment Amount | 146620.17 |
| 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 | 174 |
| Number Of Medical Services | 5847 |
| Number Of Medicare Beneficiaries With Medical Services | 3601 |
| Total Medical Submitted Charge Amount | 406261.42 |
| Total Medical Medicare Allowed Amount | 194854.85 |
| Total Medical Medicare Payment Amount | 151094.57 |
| Total Medical Medicare Standardized Payment Amount | 146620.17 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 809 |
| Number Of Beneficiaries Age 65 to 74 | 1077 |
| Number Of Beneficiaries Age 75 to 84 | 1004 |
| Number Of Beneficiaries Age Greater 84 | 711 |
| Number Of Female Beneficiaries | 2354 |
| Number Of Male Beneficiaries | 1247 |
| Number Of Non Hispanic White Beneficiaries | 2929 |
| Number Of Black or African American Beneficiaries | 511 |
| Number Of AsianPacific Islander Beneficiaries | 68 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 47 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2419 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1182 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.1372 |