| National Provider Identifier [NPI]: | 1407884737 |
| Last Name Of The Provider | WAHL |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1950 MOUNTAIN VIEW AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LONGMONT |
| Zip Code Of The Provider | 805013129 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 203 |
| Number Of Services | 7078 |
| Number Of Medicare Beneficiaries | 1569 |
| Total Submitted Charge Amount | 339327.87 |
| Total Medicare Allowed Amount | 128436.04 |
| Total Medicare Payment Amount | 96225.77 |
| Total Medicare Standardized Payment Amount | 98226.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 4343 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 7400 |
| Total Drug Medicare AllowedAmount | 1187.26 |
| Total Drug Medicare PaymentAmount | 930.75 |
| Total Drug Medicare Standardized Payment Amount | 930.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 198 |
| Number Of Medical Services | 2735 |
| Number Of Medicare Beneficiaries With Medical Services | 1569 |
| Total Medical Submitted Charge Amount | 331927.87 |
| Total Medical Medicare Allowed Amount | 127248.78 |
| Total Medical Medicare Payment Amount | 95295.02 |
| Total Medical Medicare Standardized Payment Amount | 97296.19 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 248 |
| Number Of Beneficiaries Age 65 to 74 | 641 |
| Number Of Beneficiaries Age 75 to 84 | 421 |
| Number Of Beneficiaries Age Greater 84 | 259 |
| Number Of Female Beneficiaries | 878 |
| Number Of Male Beneficiaries | 691 |
| Number Of Non Hispanic White Beneficiaries | 1385 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 138 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1255 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 314 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5385 |