| National Provider Identifier [NPI]: | 1881763217 |
| Last Name Of The Provider | WONG |
| First Name Of The Provider | EDWIN |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 555 HERNDON PARKWAY |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | HERNDON |
| Zip Code Of The Provider | 20170 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 361 |
| Number Of Medicare Beneficiaries | 92 |
| Total Submitted Charge Amount | 41584 |
| Total Medicare Allowed Amount | 20504.99 |
| Total Medicare Payment Amount | 13527.44 |
| Total Medicare Standardized Payment Amount | 12457.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 23 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 1002 |
| Total Drug Medicare AllowedAmount | 519.87 |
| Total Drug Medicare PaymentAmount | 491.76 |
| Total Drug Medicare Standardized Payment Amount | 491.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 338 |
| Number Of Medicare Beneficiaries With Medical Services | 92 |
| Total Medical Submitted Charge Amount | 40582 |
| Total Medical Medicare Allowed Amount | 19985.12 |
| Total Medical Medicare Payment Amount | 13035.68 |
| Total Medical Medicare Standardized Payment Amount | 11965.44 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 62 |
| Number Of Beneficiaries Age 75 to 84 | 17 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 46 |
| Number Of Male Beneficiaries | 46 |
| Number Of Non Hispanic White Beneficiaries | 70 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 12 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.673 |