| National Provider Identifier [NPI]: | 1568652147 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2213 CHERRY ST |
| Street Address 2 Of The Provider | ATTN: MRG ASSOCIATES, LLC - RADIOLOGY DEPT. |
| City Of The Provider | TOLEDO |
| Zip Code Of The Provider | 436082603 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 168 |
| Number Of Services | 7189 |
| Number Of Medicare Beneficiaries | 2788 |
| Total Submitted Charge Amount | 257106.6 |
| Total Medicare Allowed Amount | 126191.6 |
| Total Medicare Payment Amount | 95115.04 |
| Total Medicare Standardized Payment Amount | 98814.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3225 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 1887.6 |
| Total Drug Medicare AllowedAmount | 654.4 |
| Total Drug Medicare PaymentAmount | 512.99 |
| Total Drug Medicare Standardized Payment Amount | 512.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 166 |
| Number Of Medical Services | 3964 |
| Number Of Medicare Beneficiaries With Medical Services | 2788 |
| Total Medical Submitted Charge Amount | 255219 |
| Total Medical Medicare Allowed Amount | 125537.2 |
| Total Medical Medicare Payment Amount | 94602.05 |
| Total Medical Medicare Standardized Payment Amount | 98301.68 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 739 |
| Number Of Beneficiaries Age 65 to 74 | 954 |
| Number Of Beneficiaries Age 75 to 84 | 691 |
| Number Of Beneficiaries Age Greater 84 | 404 |
| Number Of Female Beneficiaries | 1550 |
| Number Of Male Beneficiaries | 1238 |
| Number Of Non Hispanic White Beneficiaries | 2210 |
| Number Of Black or African American Beneficiaries | 412 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 106 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 44 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1790 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 998 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.8733 |