| National Provider Identifier [NPI]: | 1447256128 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | WESLEY |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 763 E US HIGHWAY 80 |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | FORNEY |
| Zip Code Of The Provider | 751268675 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 607 |
| Number Of Medicare Beneficiaries | 109 |
| Total Submitted Charge Amount | 64362 |
| Total Medicare Allowed Amount | 30462.49 |
| Total Medicare Payment Amount | 18436.85 |
| Total Medicare Standardized Payment Amount | 23166.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 110 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 1885 |
| Total Drug Medicare AllowedAmount | 152.02 |
| Total Drug Medicare PaymentAmount | 122.11 |
| Total Drug Medicare Standardized Payment Amount | 122.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 497 |
| Number Of Medicare Beneficiaries With Medical Services | 109 |
| Total Medical Submitted Charge Amount | 62477 |
| Total Medical Medicare Allowed Amount | 30310.47 |
| Total Medical Medicare Payment Amount | 18314.74 |
| Total Medical Medicare Standardized Payment Amount | 23044.47 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 55 |
| Number Of Beneficiaries Age 75 to 84 | 17 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 64 |
| Number Of Male Beneficiaries | 45 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 92 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1035 |