| National Provider Identifier [NPI]: | 1740275403 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | RENEE |
| 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 | 235 N PEARL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BROCKTON |
| Zip Code Of The Provider | 023011794 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 1001 |
| Number Of Medicare Beneficiaries | 425 |
| Total Submitted Charge Amount | 124574.2 |
| Total Medicare Allowed Amount | 64891.78 |
| Total Medicare Payment Amount | 46636.99 |
| Total Medicare Standardized Payment Amount | 43473.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 1085.1 |
| Total Drug Medicare AllowedAmount | 212.43 |
| Total Drug Medicare PaymentAmount | 159.96 |
| Total Drug Medicare Standardized Payment Amount | 159.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 67 |
| Number Of Medical Services | 925 |
| Number Of Medicare Beneficiaries With Medical Services | 425 |
| Total Medical Submitted Charge Amount | 123489.1 |
| Total Medical Medicare Allowed Amount | 64679.35 |
| Total Medical Medicare Payment Amount | 46477.03 |
| Total Medical Medicare Standardized Payment Amount | 43313.55 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 190 |
| Number Of Beneficiaries Age 75 to 84 | 140 |
| Number Of Beneficiaries Age Greater 84 | 53 |
| Number Of Female Beneficiaries | 286 |
| Number Of Male Beneficiaries | 139 |
| Number Of Non Hispanic White Beneficiaries | 400 |
| Number Of Black or African American Beneficiaries | |
| 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 | 381 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 44 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9271 |