| National Provider Identifier [NPI]: | 1780664664 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | DUANE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 LINCOLN ST |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | KELSO |
| Zip Code Of The Provider | 986261057 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 128 |
| Number Of Services | 2835 |
| Number Of Medicare Beneficiaries | 1063 |
| Total Submitted Charge Amount | 179033.4 |
| Total Medicare Allowed Amount | 50640.97 |
| Total Medicare Payment Amount | 39485.52 |
| Total Medicare Standardized Payment Amount | 40076.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1180 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 912.4 |
| Total Drug Medicare AllowedAmount | 280.39 |
| Total Drug Medicare PaymentAmount | 219.78 |
| Total Drug Medicare Standardized Payment Amount | 219.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 125 |
| Number Of Medical Services | 1655 |
| Number Of Medicare Beneficiaries With Medical Services | 1063 |
| Total Medical Submitted Charge Amount | 178121 |
| Total Medical Medicare Allowed Amount | 50360.58 |
| Total Medical Medicare Payment Amount | 39265.74 |
| Total Medical Medicare Standardized Payment Amount | 39856.86 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 243 |
| Number Of Beneficiaries Age 65 to 74 | 404 |
| Number Of Beneficiaries Age 75 to 84 | 271 |
| Number Of Beneficiaries Age Greater 84 | 145 |
| Number Of Female Beneficiaries | 724 |
| Number Of Male Beneficiaries | 339 |
| Number Of Non Hispanic White Beneficiaries | 1004 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | 15 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 734 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 329 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4447 |