| National Provider Identifier [NPI]: | 1982675625 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | WILSON |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2030 N CHURCH PLACE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPARTANBURG |
| Zip Code Of The Provider | 293032796 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 5331 |
| Number Of Medicare Beneficiaries | 1146 |
| Total Submitted Charge Amount | 451242 |
| Total Medicare Allowed Amount | 295879.71 |
| Total Medicare Payment Amount | 222434.61 |
| Total Medicare Standardized Payment Amount | 202446.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 128 |
| Number Of Medicare Beneficiaries With Drug Services | 117 |
| Total Drug Submitted ChargeAmount | 4940 |
| Total Drug Medicare AllowedAmount | 4564.34 |
| Total Drug Medicare PaymentAmount | 4413.14 |
| Total Drug Medicare Standardized Payment Amount | 4413.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 70 |
| Number Of Medical Services | 5203 |
| Number Of Medicare Beneficiaries With Medical Services | 1146 |
| Total Medical Submitted Charge Amount | 446302 |
| Total Medical Medicare Allowed Amount | 291315.37 |
| Total Medical Medicare Payment Amount | 218021.47 |
| Total Medical Medicare Standardized Payment Amount | 198033.78 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 172 |
| Number Of Beneficiaries Age 65 to 74 | 521 |
| Number Of Beneficiaries Age 75 to 84 | 330 |
| Number Of Beneficiaries Age Greater 84 | 123 |
| Number Of Female Beneficiaries | 583 |
| Number Of Male Beneficiaries | 563 |
| Number Of Non Hispanic White Beneficiaries | 979 |
| Number Of Black or African American Beneficiaries | 154 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 934 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 212 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 23 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.9965 |