| National Provider Identifier [NPI]: | 1467693366 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | DAVONNA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1380 RIVER BEND DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 752474914 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 3 |
| Number Of Services | 590 |
| Number Of Medicare Beneficiaries | 220 |
| Total Submitted Charge Amount | 58945 |
| Total Medicare Allowed Amount | 41810.44 |
| Total Medicare Payment Amount | 27704.89 |
| Total Medicare Standardized Payment Amount | 32885.61 |
| 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 | 3 |
| Number Of Medical Services | 590 |
| Number Of Medicare Beneficiaries With Medical Services | 220 |
| Total Medical Submitted Charge Amount | 58945 |
| Total Medical Medicare Allowed Amount | 41810.44 |
| Total Medical Medicare Payment Amount | 27704.89 |
| Total Medical Medicare Standardized Payment Amount | 32885.61 |
| Average Age Of Beneficiaries | 48 |
| Number Of Beneficiaries Age Less65 | 196 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 114 |
| Number Of Male Beneficiaries | 106 |
| Number Of Non Hispanic White Beneficiaries | 90 |
| Number Of Black or African American Beneficiaries | 96 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 52 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 168 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 60 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 6 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 56 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0807 |