| National Provider Identifier [NPI]: | 1306871793 |
| Last Name Of The Provider | WIESEMANN |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4001 DUTCHMANS LN |
| Street Address 2 Of The Provider | RADIOLOGY |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 402074714 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 149 |
| Number Of Services | 4446 |
| Number Of Medicare Beneficiaries | 2886 |
| Total Submitted Charge Amount | 730768.87 |
| Total Medicare Allowed Amount | 104973.82 |
| Total Medicare Payment Amount | 78952.12 |
| Total Medicare Standardized Payment Amount | 83606.77 |
| 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 | 149 |
| Number Of Medical Services | 4446 |
| Number Of Medicare Beneficiaries With Medical Services | 2886 |
| Total Medical Submitted Charge Amount | 730768.87 |
| Total Medical Medicare Allowed Amount | 104973.82 |
| Total Medical Medicare Payment Amount | 78952.12 |
| Total Medical Medicare Standardized Payment Amount | 83606.77 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 835 |
| Number Of Beneficiaries Age 65 to 74 | 954 |
| Number Of Beneficiaries Age 75 to 84 | 725 |
| Number Of Beneficiaries Age Greater 84 | 372 |
| Number Of Female Beneficiaries | 1722 |
| Number Of Male Beneficiaries | 1164 |
| Number Of Non Hispanic White Beneficiaries | 2759 |
| Number Of Black or African American Beneficiaries | 106 |
| 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 | 1661 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1225 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5613 |