| National Provider Identifier [NPI]: | 1518957273 |
| Last Name Of The Provider | WAGNER |
| First Name Of The Provider | CHRISTINA |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 103 COMMERCE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CARMI |
| Zip Code Of The Provider | 628212223 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 648 |
| Number Of Medicare Beneficiaries | 538 |
| Total Submitted Charge Amount | 572686 |
| Total Medicare Allowed Amount | 96719.71 |
| Total Medicare Payment Amount | 74995.87 |
| Total Medicare Standardized Payment Amount | 77195.38 |
| 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 | 24 |
| Number Of Medical Services | 648 |
| Number Of Medicare Beneficiaries With Medical Services | 538 |
| Total Medical Submitted Charge Amount | 572686 |
| Total Medical Medicare Allowed Amount | 96719.71 |
| Total Medical Medicare Payment Amount | 74995.87 |
| Total Medical Medicare Standardized Payment Amount | 77195.38 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 195 |
| Number Of Beneficiaries Age 65 to 74 | 129 |
| Number Of Beneficiaries Age 75 to 84 | 118 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 290 |
| Number Of Male Beneficiaries | 248 |
| Number Of Non Hispanic White Beneficiaries | 478 |
| Number Of Black or African American Beneficiaries | |
| 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 | 315 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 223 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 49 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.0986 |