| National Provider Identifier [NPI]: | 1306832688 |
| Last Name Of The Provider | WAKEFIELD |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3731 N RAMSEY RD |
| Street Address 2 Of The Provider | SUITE 150 |
| City Of The Provider | COEUR D ALENE |
| Zip Code Of The Provider | 838159000 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Allergy/Immunology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 5942 |
| Number Of Medicare Beneficiaries | 206 |
| Total Submitted Charge Amount | 140953.5 |
| Total Medicare Allowed Amount | 84468.32 |
| Total Medicare Payment Amount | 61918.83 |
| Total Medicare Standardized Payment Amount | 63926.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 21 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 537 |
| Total Drug Medicare AllowedAmount | 447.4 |
| Total Drug Medicare PaymentAmount | 438.42 |
| Total Drug Medicare Standardized Payment Amount | 438.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 5921 |
| Number Of Medicare Beneficiaries With Medical Services | 206 |
| Total Medical Submitted Charge Amount | 140416.5 |
| Total Medical Medicare Allowed Amount | 84020.92 |
| Total Medical Medicare Payment Amount | 61480.41 |
| Total Medical Medicare Standardized Payment Amount | 63488.51 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 119 |
| Number Of Beneficiaries Age 75 to 84 | 39 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 129 |
| Number Of Male Beneficiaries | 77 |
| Number Of Non Hispanic White Beneficiaries | 194 |
| 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 | 170 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 36 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 39 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8639 |