| National Provider Identifier [NPI]: | 1427145986 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | WENDY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6820 PARKDALE PLACE |
| Street Address 2 Of The Provider | SUITE 211 |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462546600 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 3159 |
| Number Of Medicare Beneficiaries | 751 |
| Total Submitted Charge Amount | 184427 |
| Total Medicare Allowed Amount | 142179.24 |
| Total Medicare Payment Amount | 93678.53 |
| Total Medicare Standardized Payment Amount | 98334.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 64 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 16560 |
| Total Drug Medicare AllowedAmount | 14810.3 |
| Total Drug Medicare PaymentAmount | 10781.66 |
| Total Drug Medicare Standardized Payment Amount | 10781.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 3095 |
| Number Of Medicare Beneficiaries With Medical Services | 751 |
| Total Medical Submitted Charge Amount | 167867 |
| Total Medical Medicare Allowed Amount | 127368.94 |
| Total Medical Medicare Payment Amount | 82896.87 |
| Total Medical Medicare Standardized Payment Amount | 87552.38 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 407 |
| Number Of Beneficiaries Age 75 to 84 | 221 |
| Number Of Beneficiaries Age Greater 84 | 77 |
| Number Of Female Beneficiaries | 442 |
| Number Of Male Beneficiaries | 309 |
| Number Of Non Hispanic White Beneficiaries | 705 |
| Number Of Black or African American Beneficiaries | 26 |
| 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 | 703 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9637 |