| National Provider Identifier [NPI]: | 1154496040 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | JESSICA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9149 ESTATE THOMAS |
| Street Address 2 Of The Provider | PARAGON BLDG STE 202 |
| City Of The Provider | ST THOMAS |
| Zip Code Of The Provider | 008022615 |
| State Code Of The Provider | VI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 667 |
| Number Of Medicare Beneficiaries | 221 |
| Total Submitted Charge Amount | 67272.19 |
| Total Medicare Allowed Amount | 64950.34 |
| Total Medicare Payment Amount | 45050.91 |
| Total Medicare Standardized Payment Amount | 46696.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 12 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 253.96 |
| Total Drug Medicare AllowedAmount | 209.04 |
| Total Drug Medicare PaymentAmount | 203.84 |
| Total Drug Medicare Standardized Payment Amount | 203.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 655 |
| Number Of Medicare Beneficiaries With Medical Services | 219 |
| Total Medical Submitted Charge Amount | 67018.23 |
| Total Medical Medicare Allowed Amount | 64741.3 |
| Total Medical Medicare Payment Amount | 44847.07 |
| Total Medical Medicare Standardized Payment Amount | 46492.81 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 97 |
| Number Of Beneficiaries Age 75 to 84 | 77 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 122 |
| Number Of Male Beneficiaries | 99 |
| Number Of Non Hispanic White Beneficiaries | 27 |
| Number Of Black or African American Beneficiaries | 183 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 5 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 0.9846 |