| National Provider Identifier [NPI]: | 1295718013 |
| Last Name Of The Provider | HARRISON |
| First Name Of The Provider | WILLIAM |
| 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 | 800 E 20TH ST |
| Street Address 2 Of The Provider | SUITE 350 |
| City Of The Provider | CHEYENNE |
| Zip Code Of The Provider | 820013859 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 3586 |
| Number Of Medicare Beneficiaries | 465 |
| Total Submitted Charge Amount | 651178.13 |
| Total Medicare Allowed Amount | 262898 |
| Total Medicare Payment Amount | 199569.03 |
| Total Medicare Standardized Payment Amount | 198352.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 397 |
| Number Of Medicare Beneficiaries With Drug Services | 90 |
| Total Drug Submitted ChargeAmount | 11951.62 |
| Total Drug Medicare AllowedAmount | 1787.75 |
| Total Drug Medicare PaymentAmount | 1592.4 |
| Total Drug Medicare Standardized Payment Amount | 1592.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 3189 |
| Number Of Medicare Beneficiaries With Medical Services | 460 |
| Total Medical Submitted Charge Amount | 639226.51 |
| Total Medical Medicare Allowed Amount | 261110.25 |
| Total Medical Medicare Payment Amount | 197976.63 |
| Total Medical Medicare Standardized Payment Amount | 196760.35 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 156 |
| Number Of Beneficiaries Age 75 to 84 | 159 |
| Number Of Beneficiaries Age Greater 84 | 107 |
| Number Of Female Beneficiaries | 274 |
| Number Of Male Beneficiaries | 191 |
| Number Of Non Hispanic White Beneficiaries | 424 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 29 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 416 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 1.3213 |