| National Provider Identifier [NPI]: | 1255382438 |
| Last Name Of The Provider | ANDERSEN |
| First Name Of The Provider | WESLEY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3291 S THOMPSON ST STE C101 |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGDALE |
| Zip Code Of The Provider | 727647343 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 384 |
| Number Of Medicare Beneficiaries | 276 |
| Total Submitted Charge Amount | 60755 |
| Total Medicare Allowed Amount | 41693.21 |
| Total Medicare Payment Amount | 29826.75 |
| Total Medicare Standardized Payment Amount | 33142.89 |
| 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 | 9 |
| Number Of Medical Services | 384 |
| Number Of Medicare Beneficiaries With Medical Services | 276 |
| Total Medical Submitted Charge Amount | 60755 |
| Total Medical Medicare Allowed Amount | 41693.21 |
| Total Medical Medicare Payment Amount | 29826.75 |
| Total Medical Medicare Standardized Payment Amount | 33142.89 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 67 |
| Number Of Beneficiaries Age 75 to 84 | 65 |
| Number Of Beneficiaries Age Greater 84 | 87 |
| Number Of Female Beneficiaries | 207 |
| Number Of Male Beneficiaries | 69 |
| Number Of Non Hispanic White Beneficiaries | 245 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 69 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 207 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 55 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.6149 |