| National Provider Identifier [NPI]: | 1326250234 |
| Last Name Of The Provider | WYNN |
| First Name Of The Provider | BRANDON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3050 MONTVALE DR STE A |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627046924 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 182 |
| Number Of Services | 5428 |
| Number Of Medicare Beneficiaries | 3688 |
| Total Submitted Charge Amount | 678401.66 |
| Total Medicare Allowed Amount | 142412.71 |
| Total Medicare Payment Amount | 106617.9 |
| Total Medicare Standardized Payment Amount | 110654.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 547 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 1599.58 |
| Total Drug Medicare AllowedAmount | 235.68 |
| Total Drug Medicare PaymentAmount | 184.79 |
| Total Drug Medicare Standardized Payment Amount | 184.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 178 |
| Number Of Medical Services | 4881 |
| Number Of Medicare Beneficiaries With Medical Services | 3688 |
| Total Medical Submitted Charge Amount | 676802.08 |
| Total Medical Medicare Allowed Amount | 142177.03 |
| Total Medical Medicare Payment Amount | 106433.11 |
| Total Medical Medicare Standardized Payment Amount | 110469.98 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 690 |
| Number Of Beneficiaries Age 65 to 74 | 1347 |
| Number Of Beneficiaries Age 75 to 84 | 1058 |
| Number Of Beneficiaries Age Greater 84 | 593 |
| Number Of Female Beneficiaries | 2239 |
| Number Of Male Beneficiaries | 1449 |
| Number Of Non Hispanic White Beneficiaries | 3480 |
| Number Of Black or African American Beneficiaries | 144 |
| 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 | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2641 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1047 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5206 |