| National Provider Identifier [NPI]: | 1003836248 |
| Last Name Of The Provider | WAGNER |
| First Name Of The Provider | WILLIS |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8631 W 3RD ST |
| Street Address 2 Of The Provider | SUITE 615E |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900485901 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Vascular Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 4016 |
| Number Of Medicare Beneficiaries | 2858 |
| Total Submitted Charge Amount | 1819526 |
| Total Medicare Allowed Amount | 344652.8 |
| Total Medicare Payment Amount | 267298.3 |
| Total Medicare Standardized Payment Amount | 260701.97 |
| 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 | 79 |
| Number Of Medical Services | 4016 |
| Number Of Medicare Beneficiaries With Medical Services | 2858 |
| Total Medical Submitted Charge Amount | 1819526 |
| Total Medical Medicare Allowed Amount | 344652.8 |
| Total Medical Medicare Payment Amount | 267298.3 |
| Total Medical Medicare Standardized Payment Amount | 260701.97 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 350 |
| Number Of Beneficiaries Age 65 to 74 | 938 |
| Number Of Beneficiaries Age 75 to 84 | 885 |
| Number Of Beneficiaries Age Greater 84 | 685 |
| Number Of Female Beneficiaries | 1426 |
| Number Of Male Beneficiaries | 1432 |
| Number Of Non Hispanic White Beneficiaries | 1911 |
| Number Of Black or African American Beneficiaries | 423 |
| Number Of AsianPacific Islander Beneficiaries | 184 |
| Number Of Hispanic Beneficiaries | 263 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1710 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1148 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 69 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.7218 |