| National Provider Identifier [NPI]: | 1124059803 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3501 HEALTH CENTER BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BONITA SPRINGS |
| Zip Code Of The Provider | 341358127 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 3331 |
| Number Of Medicare Beneficiaries | 1667 |
| Total Submitted Charge Amount | 215345.61 |
| Total Medicare Allowed Amount | 205955.16 |
| Total Medicare Payment Amount | 126391.09 |
| Total Medicare Standardized Payment Amount | 122637.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 308 |
| Number Of Medicare Beneficiaries With Drug Services | 117 |
| Total Drug Submitted ChargeAmount | 1863.13 |
| Total Drug Medicare AllowedAmount | 1426.64 |
| Total Drug Medicare PaymentAmount | 1044.97 |
| Total Drug Medicare Standardized Payment Amount | 1044.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 3023 |
| Number Of Medicare Beneficiaries With Medical Services | 1667 |
| Total Medical Submitted Charge Amount | 213482.48 |
| Total Medical Medicare Allowed Amount | 204528.52 |
| Total Medical Medicare Payment Amount | 125346.12 |
| Total Medical Medicare Standardized Payment Amount | 121592.22 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 874 |
| Number Of Beneficiaries Age 75 to 84 | 599 |
| Number Of Beneficiaries Age Greater 84 | 159 |
| Number Of Female Beneficiaries | 906 |
| Number Of Male Beneficiaries | 761 |
| Number Of Non Hispanic White Beneficiaries | 1609 |
| 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 | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1645 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9168 |