| National Provider Identifier [NPI]: | 1528009768 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 222 PIEDMONT AVE |
| Street Address 2 Of The Provider | SUITE 5200 |
| City Of The Provider | CINCINNATI |
| Zip Code Of The Provider | 452194231 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Otolaryngology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 136 |
| Number Of Services | 1527 |
| Number Of Medicare Beneficiaries | 351 |
| Total Submitted Charge Amount | 524790 |
| Total Medicare Allowed Amount | 177806.72 |
| Total Medicare Payment Amount | 134932.84 |
| Total Medicare Standardized Payment Amount | 137561.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 367 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 4037 |
| Total Drug Medicare AllowedAmount | 2011.82 |
| Total Drug Medicare PaymentAmount | 1334.01 |
| Total Drug Medicare Standardized Payment Amount | 1334.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 135 |
| Number Of Medical Services | 1160 |
| Number Of Medicare Beneficiaries With Medical Services | 351 |
| Total Medical Submitted Charge Amount | 520753 |
| Total Medical Medicare Allowed Amount | 175794.9 |
| Total Medical Medicare Payment Amount | 133598.83 |
| Total Medical Medicare Standardized Payment Amount | 136227.01 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | 160 |
| Number Of Beneficiaries Age 75 to 84 | 87 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 185 |
| Number Of Male Beneficiaries | 166 |
| Number Of Non Hispanic White Beneficiaries | 285 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 271 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 80 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.6088 |