| National Provider Identifier [NPI]: | 1861461402 |
| Last Name Of The Provider | WIEGAND |
| First Name Of The Provider | TORSTEN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD PHD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 50 STANIFORD ST |
| Street Address 2 Of The Provider | SUITE 600 |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 021142517 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 20759 |
| Number Of Medicare Beneficiaries | 2144 |
| Total Submitted Charge Amount | 12522006.5 |
| Total Medicare Allowed Amount | 4664480.13 |
| Total Medicare Payment Amount | 3598280.57 |
| Total Medicare Standardized Payment Amount | 3524925.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 9095 |
| Number Of Medicare Beneficiaries With Drug Services | 513 |
| Total Drug Submitted ChargeAmount | 7486227.5 |
| Total Drug Medicare AllowedAmount | 3585321.77 |
| Total Drug Medicare PaymentAmount | 2801889.8 |
| Total Drug Medicare Standardized Payment Amount | 2801889.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 11664 |
| Number Of Medicare Beneficiaries With Medical Services | 2144 |
| Total Medical Submitted Charge Amount | 5035779 |
| Total Medical Medicare Allowed Amount | 1079158.36 |
| Total Medical Medicare Payment Amount | 796390.77 |
| Total Medical Medicare Standardized Payment Amount | 723035.35 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 668 |
| Number Of Beneficiaries Age 75 to 84 | 800 |
| Number Of Beneficiaries Age Greater 84 | 617 |
| Number Of Female Beneficiaries | 1287 |
| Number Of Male Beneficiaries | 857 |
| Number Of Non Hispanic White Beneficiaries | 2016 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 41 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2004 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 140 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2662 |