| National Provider Identifier [NPI]: | 1851307367 |
| Last Name Of The Provider | WILDING |
| First Name Of The Provider | BRANDON |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1055 N CURTIS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOISE |
| Zip Code Of The Provider | 837061309 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 312 |
| Number Of Medicare Beneficiaries | 209 |
| Total Submitted Charge Amount | 166217 |
| Total Medicare Allowed Amount | 33610.79 |
| Total Medicare Payment Amount | 25878.58 |
| Total Medicare Standardized Payment Amount | 27169.32 |
| 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 | 22 |
| Number Of Medical Services | 312 |
| Number Of Medicare Beneficiaries With Medical Services | 209 |
| Total Medical Submitted Charge Amount | 166217 |
| Total Medical Medicare Allowed Amount | 33610.79 |
| Total Medical Medicare Payment Amount | 25878.58 |
| Total Medical Medicare Standardized Payment Amount | 27169.32 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 101 |
| Number Of Beneficiaries Age 65 to 74 | 42 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 28 |
| Number Of Female Beneficiaries | 126 |
| Number Of Male Beneficiaries | 83 |
| Number Of Non Hispanic White Beneficiaries | 182 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 89 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 120 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 52 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.6969 |