| National Provider Identifier [NPI]: | 1528120748 |
| Last Name Of The Provider | LIU |
| First Name Of The Provider | WILSON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 HOSPITAL DR |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | VALLEJO |
| Zip Code Of The Provider | 945892580 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 122 |
| Number Of Medicare Beneficiaries | 63 |
| Total Submitted Charge Amount | 35339 |
| Total Medicare Allowed Amount | 11134.67 |
| Total Medicare Payment Amount | 8299.25 |
| Total Medicare Standardized Payment Amount | 7409.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 623 |
| Total Drug Medicare AllowedAmount | 380.69 |
| Total Drug Medicare PaymentAmount | 373.06 |
| Total Drug Medicare Standardized Payment Amount | 373.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 107 |
| Number Of Medicare Beneficiaries With Medical Services | 63 |
| Total Medical Submitted Charge Amount | 34716 |
| Total Medical Medicare Allowed Amount | 10753.98 |
| Total Medical Medicare Payment Amount | 7926.19 |
| Total Medical Medicare Standardized Payment Amount | 7036.41 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 23 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 39 |
| Number Of Male Beneficiaries | 24 |
| Number Of Non Hispanic White Beneficiaries | 31 |
| Number Of Black or African American Beneficiaries | 15 |
| 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 | 52 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 22 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3784 |