| National Provider Identifier [NPI]: | 1013062009 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | MARLENE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1920 CHURCHMAN AVE APT A |
| Street Address 2 Of The Provider | |
| City Of The Provider | BEECH GROVE |
| Zip Code Of The Provider | 461071000 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 4966 |
| Number Of Medicare Beneficiaries | 876 |
| Total Submitted Charge Amount | 565463 |
| Total Medicare Allowed Amount | 300449.7 |
| Total Medicare Payment Amount | 219410.13 |
| Total Medicare Standardized Payment Amount | 279844.14 |
| 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 | 13 |
| Number Of Medical Services | 4966 |
| Number Of Medicare Beneficiaries With Medical Services | 876 |
| Total Medical Submitted Charge Amount | 565463 |
| Total Medical Medicare Allowed Amount | 300449.7 |
| Total Medical Medicare Payment Amount | 219410.13 |
| Total Medical Medicare Standardized Payment Amount | 279844.14 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 151 |
| Number Of Beneficiaries Age 65 to 74 | 197 |
| Number Of Beneficiaries Age 75 to 84 | 247 |
| Number Of Beneficiaries Age Greater 84 | 281 |
| Number Of Female Beneficiaries | 550 |
| Number Of Male Beneficiaries | 326 |
| Number Of Non Hispanic White Beneficiaries | 737 |
| Number Of Black or African American Beneficiaries | 119 |
| 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 | 256 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 620 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 60 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 54 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 27 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.3783 |