| National Provider Identifier [NPI]: | 1700820396 |
| Last Name Of The Provider | WILD |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 396 MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LUMBERTON |
| Zip Code Of The Provider | 080489566 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 2109 |
| Number Of Medicare Beneficiaries | 1433 |
| Total Submitted Charge Amount | 765882 |
| Total Medicare Allowed Amount | 242815.45 |
| Total Medicare Payment Amount | 185519.71 |
| Total Medicare Standardized Payment Amount | 183686.83 |
| 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 | 40 |
| Number Of Medical Services | 2109 |
| Number Of Medicare Beneficiaries With Medical Services | 1433 |
| Total Medical Submitted Charge Amount | 765882 |
| Total Medical Medicare Allowed Amount | 242815.45 |
| Total Medical Medicare Payment Amount | 185519.71 |
| Total Medical Medicare Standardized Payment Amount | 183686.83 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 278 |
| Number Of Beneficiaries Age 65 to 74 | 462 |
| Number Of Beneficiaries Age 75 to 84 | 426 |
| Number Of Beneficiaries Age Greater 84 | 267 |
| Number Of Female Beneficiaries | 781 |
| Number Of Male Beneficiaries | 652 |
| Number Of Non Hispanic White Beneficiaries | 1129 |
| Number Of Black or African American Beneficiaries | 276 |
| 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 | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1045 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 388 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.9549 |