| National Provider Identifier [NPI]: | 1609825728 |
| Last Name Of The Provider | WILHELM |
| First Name Of The Provider | LORI |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 77-311 SUNSET DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | KAILUA KONA |
| Zip Code Of The Provider | 96740 |
| State Code Of The Provider | HI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 163 |
| Number Of Services | 12302 |
| Number Of Medicare Beneficiaries | 1569 |
| Total Submitted Charge Amount | 1447329.55 |
| Total Medicare Allowed Amount | 280056.41 |
| Total Medicare Payment Amount | 211926.86 |
| Total Medicare Standardized Payment Amount | 192010.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 9228 |
| Number Of Medicare Beneficiaries With Drug Services | 141 |
| Total Drug Submitted ChargeAmount | 30627 |
| Total Drug Medicare AllowedAmount | 2621.35 |
| Total Drug Medicare PaymentAmount | 2054.82 |
| Total Drug Medicare Standardized Payment Amount | 2054.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 160 |
| Number Of Medical Services | 3074 |
| Number Of Medicare Beneficiaries With Medical Services | 1569 |
| Total Medical Submitted Charge Amount | 1416702.55 |
| Total Medical Medicare Allowed Amount | 277435.06 |
| Total Medical Medicare Payment Amount | 209872.04 |
| Total Medical Medicare Standardized Payment Amount | 189956.11 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 196 |
| Number Of Beneficiaries Age 65 to 74 | 752 |
| Number Of Beneficiaries Age 75 to 84 | 420 |
| Number Of Beneficiaries Age Greater 84 | 201 |
| Number Of Female Beneficiaries | 947 |
| Number Of Male Beneficiaries | 622 |
| Number Of Non Hispanic White Beneficiaries | 973 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 413 |
| Number Of Hispanic Beneficiaries | 73 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 91 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1302 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 267 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1715 |