| National Provider Identifier [NPI]: | 1316993272 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | KATHLEEN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 24810 BURNT PINE DR |
| Street Address 2 Of The Provider | SUITE 3 |
| City Of The Provider | BONITA SPRINGS |
| Zip Code Of The Provider | 341341973 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 1512 |
| Number Of Medicare Beneficiaries | 316 |
| Total Submitted Charge Amount | 232058.4 |
| Total Medicare Allowed Amount | 119954.29 |
| Total Medicare Payment Amount | 87467.79 |
| Total Medicare Standardized Payment Amount | 83798.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 109 |
| Number Of Medicare Beneficiaries With Drug Services | 109 |
| Total Drug Submitted ChargeAmount | 1951.76 |
| Total Drug Medicare AllowedAmount | 1725.3 |
| Total Drug Medicare PaymentAmount | 1673.98 |
| Total Drug Medicare Standardized Payment Amount | 1673.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 1403 |
| Number Of Medicare Beneficiaries With Medical Services | 316 |
| Total Medical Submitted Charge Amount | 230106.64 |
| Total Medical Medicare Allowed Amount | 118228.99 |
| Total Medical Medicare Payment Amount | 85793.81 |
| Total Medical Medicare Standardized Payment Amount | 82124.54 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 0 |
| Number Of Beneficiaries Age 65 to 74 | 139 |
| Number Of Beneficiaries Age 75 to 84 | 137 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 172 |
| Number Of Male Beneficiaries | 144 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 316 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 0 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 8 |
| Percent Of With Diabetes | 11 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9755 |