| National Provider Identifier [NPI]: | 1164482253 |
| Last Name Of The Provider | WIATER |
| First Name Of The Provider | BRIDGET |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3601 W 13 MILE RD |
| Street Address 2 Of The Provider | 400 FSC-PCS |
| City Of The Provider | ROYAL OAK |
| Zip Code Of The Provider | 48073 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 93 |
| Number Of Services | 4777 |
| Number Of Medicare Beneficiaries | 3398 |
| Total Submitted Charge Amount | 215524 |
| Total Medicare Allowed Amount | 112735.39 |
| Total Medicare Payment Amount | 82320.88 |
| Total Medicare Standardized Payment Amount | 79993.84 |
| 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 | 93 |
| Number Of Medical Services | 4777 |
| Number Of Medicare Beneficiaries With Medical Services | 3398 |
| Total Medical Submitted Charge Amount | 215524 |
| Total Medical Medicare Allowed Amount | 112735.39 |
| Total Medical Medicare Payment Amount | 82320.88 |
| Total Medical Medicare Standardized Payment Amount | 79993.84 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 622 |
| Number Of Beneficiaries Age 65 to 74 | 887 |
| Number Of Beneficiaries Age 75 to 84 | 1001 |
| Number Of Beneficiaries Age Greater 84 | 888 |
| Number Of Female Beneficiaries | 2036 |
| Number Of Male Beneficiaries | 1362 |
| Number Of Non Hispanic White Beneficiaries | 2581 |
| Number Of Black or African American Beneficiaries | 635 |
| Number Of AsianPacific Islander Beneficiaries | 63 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 81 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2483 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 915 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 21 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.3439 |