| National Provider Identifier [NPI]: | 1164420923 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1521 S STAPLES ST |
| Street Address 2 Of The Provider | SUITES 104, 301 & 304 |
| City Of The Provider | CORPUS CHRISTI |
| Zip Code Of The Provider | 784043150 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 197 |
| Number Of Services | 25378 |
| Number Of Medicare Beneficiaries | 3082 |
| Total Submitted Charge Amount | 1399723.21 |
| Total Medicare Allowed Amount | 506432.63 |
| Total Medicare Payment Amount | 385757.3 |
| Total Medicare Standardized Payment Amount | 407717.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 20696 |
| Number Of Medicare Beneficiaries With Drug Services | 264 |
| Total Drug Submitted ChargeAmount | 13976.54 |
| Total Drug Medicare AllowedAmount | 6000.92 |
| Total Drug Medicare PaymentAmount | 4669.95 |
| Total Drug Medicare Standardized Payment Amount | 4669.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 193 |
| Number Of Medical Services | 4682 |
| Number Of Medicare Beneficiaries With Medical Services | 3081 |
| Total Medical Submitted Charge Amount | 1385746.67 |
| Total Medical Medicare Allowed Amount | 500431.71 |
| Total Medical Medicare Payment Amount | 381087.35 |
| Total Medical Medicare Standardized Payment Amount | 403047.23 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 513 |
| Number Of Beneficiaries Age 65 to 74 | 1269 |
| Number Of Beneficiaries Age 75 to 84 | 880 |
| Number Of Beneficiaries Age Greater 84 | 420 |
| Number Of Female Beneficiaries | 1929 |
| Number Of Male Beneficiaries | 1153 |
| Number Of Non Hispanic White Beneficiaries | 1803 |
| Number Of Black or African American Beneficiaries | 67 |
| Number Of AsianPacific Islander Beneficiaries | 33 |
| Number Of Hispanic Beneficiaries | 1156 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2296 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 786 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6794 |