| National Provider Identifier [NPI]: | 1356347561 |
| Last Name Of The Provider | WADSWORTH |
| First Name Of The Provider | LYLE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 890 N BOUNDARY AVE |
| Street Address 2 Of The Provider | STE 102 |
| City Of The Provider | DELAND |
| Zip Code Of The Provider | 327203173 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 2645 |
| Number Of Medicare Beneficiaries | 754 |
| Total Submitted Charge Amount | 205999.06 |
| Total Medicare Allowed Amount | 179218.32 |
| Total Medicare Payment Amount | 126102.63 |
| Total Medicare Standardized Payment Amount | 126403.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 140 |
| Number Of Medicare Beneficiaries With Drug Services | 135 |
| Total Drug Submitted ChargeAmount | 4481 |
| Total Drug Medicare AllowedAmount | 3122.38 |
| Total Drug Medicare PaymentAmount | 3053.33 |
| Total Drug Medicare Standardized Payment Amount | 3053.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 2505 |
| Number Of Medicare Beneficiaries With Medical Services | 754 |
| Total Medical Submitted Charge Amount | 201518.06 |
| Total Medical Medicare Allowed Amount | 176095.94 |
| Total Medical Medicare Payment Amount | 123049.3 |
| Total Medical Medicare Standardized Payment Amount | 123350.6 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 205 |
| Number Of Beneficiaries Age 75 to 84 | 254 |
| Number Of Beneficiaries Age Greater 84 | 251 |
| Number Of Female Beneficiaries | 476 |
| Number Of Male Beneficiaries | 278 |
| Number Of Non Hispanic White Beneficiaries | 685 |
| Number Of Black or African American Beneficiaries | 38 |
| 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 | 619 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 135 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5348 |