| National Provider Identifier [NPI]: | 1972594471 |
| Last Name Of The Provider | WAGNER |
| First Name Of The Provider | JASON |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 940 NE 13TH ST |
| Street Address 2 Of The Provider | SUITE 4G4250 |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 731045008 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 168 |
| Number Of Services | 4003 |
| Number Of Medicare Beneficiaries | 2135 |
| Total Submitted Charge Amount | 651238 |
| Total Medicare Allowed Amount | 120121.34 |
| Total Medicare Payment Amount | 92846.34 |
| Total Medicare Standardized Payment Amount | 98504.05 |
| 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 | 168 |
| Number Of Medical Services | 4003 |
| Number Of Medicare Beneficiaries With Medical Services | 2135 |
| Total Medical Submitted Charge Amount | 651238 |
| Total Medical Medicare Allowed Amount | 120121.34 |
| Total Medical Medicare Payment Amount | 92846.34 |
| Total Medical Medicare Standardized Payment Amount | 98504.05 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 647 |
| Number Of Beneficiaries Age 65 to 74 | 757 |
| Number Of Beneficiaries Age 75 to 84 | 496 |
| Number Of Beneficiaries Age Greater 84 | 235 |
| Number Of Female Beneficiaries | 1266 |
| Number Of Male Beneficiaries | 869 |
| Number Of Non Hispanic White Beneficiaries | 1647 |
| Number Of Black or African American Beneficiaries | 284 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 53 |
| Number Of American Indian Alaska Native Beneficiaries | 121 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1384 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 751 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.9626 |