| National Provider Identifier [NPI]: | 1467490011 |
| Last Name Of The Provider | WIEBE-KING |
| First Name Of The Provider | STEVEN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2602 BUFORD RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | RICHMOND |
| Zip Code Of The Provider | 232353422 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 182 |
| Number Of Services | 8209 |
| Number Of Medicare Beneficiaries | 4614 |
| Total Submitted Charge Amount | 720542.27 |
| Total Medicare Allowed Amount | 198641.92 |
| Total Medicare Payment Amount | 155858.78 |
| Total Medicare Standardized Payment Amount | 160087.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1595 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 3865.5 |
| Total Drug Medicare AllowedAmount | 368.51 |
| Total Drug Medicare PaymentAmount | 279.79 |
| Total Drug Medicare Standardized Payment Amount | 279.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 180 |
| Number Of Medical Services | 6614 |
| Number Of Medicare Beneficiaries With Medical Services | 4614 |
| Total Medical Submitted Charge Amount | 716676.77 |
| Total Medical Medicare Allowed Amount | 198273.41 |
| Total Medical Medicare Payment Amount | 155578.99 |
| Total Medical Medicare Standardized Payment Amount | 159808.14 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 701 |
| Number Of Beneficiaries Age 65 to 74 | 1613 |
| Number Of Beneficiaries Age 75 to 84 | 1417 |
| Number Of Beneficiaries Age Greater 84 | 883 |
| Number Of Female Beneficiaries | 2920 |
| Number Of Male Beneficiaries | 1694 |
| Number Of Non Hispanic White Beneficiaries | 3188 |
| Number Of Black or African American Beneficiaries | 1289 |
| Number Of AsianPacific Islander Beneficiaries | 55 |
| Number Of Hispanic Beneficiaries | 42 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3631 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 983 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.7524 |