| National Provider Identifier [NPI]: | 1639504962 |
| Last Name Of The Provider | WAHLGREN |
| First Name Of The Provider | REBECCA |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7547 CLAREMONT AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BERKELEY |
| Zip Code Of The Provider | 947051432 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 249 |
| Number Of Medicare Beneficiaries | 143 |
| Total Submitted Charge Amount | 39054 |
| Total Medicare Allowed Amount | 12933.85 |
| Total Medicare Payment Amount | 9852.23 |
| Total Medicare Standardized Payment Amount | 10081.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 25 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 1180 |
| Total Drug Medicare AllowedAmount | 372.74 |
| Total Drug Medicare PaymentAmount | 364.32 |
| Total Drug Medicare Standardized Payment Amount | 364.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 224 |
| Number Of Medicare Beneficiaries With Medical Services | 143 |
| Total Medical Submitted Charge Amount | 37874 |
| Total Medical Medicare Allowed Amount | 12561.11 |
| Total Medical Medicare Payment Amount | 9487.91 |
| Total Medical Medicare Standardized Payment Amount | 9717.22 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 61 |
| Number Of Beneficiaries Age 75 to 84 | 39 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 99 |
| Number Of Male Beneficiaries | 44 |
| Number Of Non Hispanic White Beneficiaries | 85 |
| Number Of Black or African American Beneficiaries | 25 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 115 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 20 |
| 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 | 0.974 |