| National Provider Identifier [NPI]: | 1912980079 |
| Last Name Of The Provider | WIVELL |
| First Name Of The Provider | WAYNE |
| 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 | 585 LEBANON STREET |
| Street Address 2 Of The Provider | MELROSE-WAKEFIELD HOSPITAL |
| City Of The Provider | MELROSE |
| Zip Code Of The Provider | 02176 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 182 |
| Number Of Services | 2363 |
| Number Of Medicare Beneficiaries | 1444 |
| Total Submitted Charge Amount | 302689 |
| Total Medicare Allowed Amount | 104009.1 |
| Total Medicare Payment Amount | 78891.84 |
| Total Medicare Standardized Payment Amount | 76085.02 |
| 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 | 182 |
| Number Of Medical Services | 2363 |
| Number Of Medicare Beneficiaries With Medical Services | 1444 |
| Total Medical Submitted Charge Amount | 302689 |
| Total Medical Medicare Allowed Amount | 104009.1 |
| Total Medical Medicare Payment Amount | 78891.84 |
| Total Medical Medicare Standardized Payment Amount | 76085.02 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 229 |
| Number Of Beneficiaries Age 65 to 74 | 432 |
| Number Of Beneficiaries Age 75 to 84 | 463 |
| Number Of Beneficiaries Age Greater 84 | 320 |
| Number Of Female Beneficiaries | 909 |
| Number Of Male Beneficiaries | 535 |
| Number Of Non Hispanic White Beneficiaries | 1356 |
| Number Of Black or African American Beneficiaries | 25 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1007 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 437 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.6432 |