| National Provider Identifier [NPI]: | 1154308039 |
| Last Name Of The Provider | WAGNER |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2160 S 1ST AVE |
| Street Address 2 Of The Provider | (MCGAW ENT., RM 47) |
| City Of The Provider | MAYWOOD |
| Zip Code Of The Provider | 60153 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 2773 |
| Number Of Medicare Beneficiaries | 2443 |
| Total Submitted Charge Amount | 595461 |
| Total Medicare Allowed Amount | 132801.73 |
| Total Medicare Payment Amount | 101344.17 |
| Total Medicare Standardized Payment Amount | 96117.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 2773 |
| Number Of Medicare Beneficiaries With Medical Services | 2443 |
| Total Medical Submitted Charge Amount | 595461 |
| Total Medical Medicare Allowed Amount | 132801.73 |
| Total Medical Medicare Payment Amount | 101344.17 |
| Total Medical Medicare Standardized Payment Amount | 96117.26 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 314 |
| Number Of Beneficiaries Age 65 to 74 | 1149 |
| Number Of Beneficiaries Age 75 to 84 | 747 |
| Number Of Beneficiaries Age Greater 84 | 233 |
| Number Of Female Beneficiaries | 1530 |
| Number Of Male Beneficiaries | 913 |
| Number Of Non Hispanic White Beneficiaries | 1730 |
| Number Of Black or African American Beneficiaries | 358 |
| Number Of AsianPacific Islander Beneficiaries | 46 |
| Number Of Hispanic Beneficiaries | 269 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1958 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 485 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 24 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.6577 |