| National Provider Identifier [NPI]: | 1083619332 |
| Last Name Of The Provider | JUSTICE |
| First Name Of The Provider | WILEY |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5721 USA NORTH DR |
| Street Address 2 Of The Provider | HAHN 1119 |
| City Of The Provider | MOBILE |
| Zip Code Of The Provider | 366880002 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Otolaryngology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 2322 |
| Number Of Medicare Beneficiaries | 422 |
| Total Submitted Charge Amount | 110272 |
| Total Medicare Allowed Amount | 61107.62 |
| Total Medicare Payment Amount | 41898.71 |
| Total Medicare Standardized Payment Amount | 44586.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 1292 |
| Number Of Medicare Beneficiaries With Drug Services | 96 |
| Total Drug Submitted ChargeAmount | 5115 |
| Total Drug Medicare AllowedAmount | 2141.43 |
| Total Drug Medicare PaymentAmount | 1504.94 |
| Total Drug Medicare Standardized Payment Amount | 1504.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 1030 |
| Number Of Medicare Beneficiaries With Medical Services | 422 |
| Total Medical Submitted Charge Amount | 105157 |
| Total Medical Medicare Allowed Amount | 58966.19 |
| Total Medical Medicare Payment Amount | 40393.77 |
| Total Medical Medicare Standardized Payment Amount | 43081.23 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 56 |
| Number Of Beneficiaries Age 65 to 74 | 171 |
| Number Of Beneficiaries Age 75 to 84 | 122 |
| Number Of Beneficiaries Age Greater 84 | 73 |
| Number Of Female Beneficiaries | 250 |
| Number Of Male Beneficiaries | 172 |
| Number Of Non Hispanic White Beneficiaries | 351 |
| 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 | 385 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9835 |