| National Provider Identifier [NPI]: | 1609852359 |
| Last Name Of The Provider | WIEGEL |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5901 TECHNOLOGY CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462786013 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 209 |
| Number Of Services | 11541 |
| Number Of Medicare Beneficiaries | 6112 |
| Total Submitted Charge Amount | 951531 |
| Total Medicare Allowed Amount | 336555.47 |
| Total Medicare Payment Amount | 261565.8 |
| Total Medicare Standardized Payment Amount | 274325.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3661 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 2318 |
| Total Drug Medicare AllowedAmount | 830.6 |
| Total Drug Medicare PaymentAmount | 651.16 |
| Total Drug Medicare Standardized Payment Amount | 651.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 207 |
| Number Of Medical Services | 7880 |
| Number Of Medicare Beneficiaries With Medical Services | 6112 |
| Total Medical Submitted Charge Amount | 949213 |
| Total Medical Medicare Allowed Amount | 335724.87 |
| Total Medical Medicare Payment Amount | 260914.64 |
| Total Medical Medicare Standardized Payment Amount | 273674.23 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 1160 |
| Number Of Beneficiaries Age 65 to 74 | 2216 |
| Number Of Beneficiaries Age 75 to 84 | 1773 |
| Number Of Beneficiaries Age Greater 84 | 963 |
| Number Of Female Beneficiaries | 3674 |
| Number Of Male Beneficiaries | 2438 |
| Number Of Non Hispanic White Beneficiaries | 5450 |
| Number Of Black or African American Beneficiaries | 495 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 54 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 70 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4529 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1583 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7534 |