| National Provider Identifier [NPI]: | 1891768388 |
| Last Name Of The Provider | WATANABE |
| First Name Of The Provider | WILSON |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10300 W CHARLESTON BLVD STE 13-342 |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891351037 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 770 |
| Number Of Medicare Beneficiaries | 317 |
| Total Submitted Charge Amount | 363966 |
| Total Medicare Allowed Amount | 116947.68 |
| Total Medicare Payment Amount | 89916.12 |
| Total Medicare Standardized Payment Amount | 89806.35 |
| 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 | 27 |
| Number Of Medical Services | 770 |
| Number Of Medicare Beneficiaries With Medical Services | 317 |
| Total Medical Submitted Charge Amount | 363966 |
| Total Medical Medicare Allowed Amount | 116947.68 |
| Total Medical Medicare Payment Amount | 89916.12 |
| Total Medical Medicare Standardized Payment Amount | 89806.35 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 124 |
| Number Of Beneficiaries Age 75 to 84 | 98 |
| Number Of Beneficiaries Age Greater 84 | 48 |
| Number Of Female Beneficiaries | 137 |
| Number Of Male Beneficiaries | 180 |
| Number Of Non Hispanic White Beneficiaries | 247 |
| Number Of Black or African American Beneficiaries | 21 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 260 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 32 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 56 |
| Percent Of With Chronic Kidney Disease | 67 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 49 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 2.4563 |