| National Provider Identifier [NPI]: | 1922030832 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1325 PENNSYLVANIA AVE |
| Street Address 2 Of The Provider | SUITE 560 |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 761042158 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Endocrinology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 5396 |
| Number Of Medicare Beneficiaries | 528 |
| Total Submitted Charge Amount | 163819.41 |
| Total Medicare Allowed Amount | 158722.97 |
| Total Medicare Payment Amount | 113333.03 |
| Total Medicare Standardized Payment Amount | 117984.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 2387 |
| Number Of Medicare Beneficiaries With Drug Services | 69 |
| Total Drug Submitted ChargeAmount | 34195.96 |
| Total Drug Medicare AllowedAmount | 34195.96 |
| Total Drug Medicare PaymentAmount | 26729.95 |
| Total Drug Medicare Standardized Payment Amount | 26729.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 3009 |
| Number Of Medicare Beneficiaries With Medical Services | 528 |
| Total Medical Submitted Charge Amount | 129623.45 |
| Total Medical Medicare Allowed Amount | 124527.01 |
| Total Medical Medicare Payment Amount | 86603.08 |
| Total Medical Medicare Standardized Payment Amount | 91254.86 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 285 |
| Number Of Beneficiaries Age 75 to 84 | 153 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 292 |
| Number Of Male Beneficiaries | 236 |
| Number Of Non Hispanic White Beneficiaries | 473 |
| Number Of Black or African American Beneficiaries | 30 |
| 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 | 507 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 70 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.575 |