| National Provider Identifier [NPI]: | 1558475657 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | PAULETTE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1150 W FULLERTON AVE |
| Street Address 2 Of The Provider | 2ND FLR |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606148160 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 729 |
| Number Of Medicare Beneficiaries | 164 |
| Total Submitted Charge Amount | 105173 |
| Total Medicare Allowed Amount | 47035.17 |
| Total Medicare Payment Amount | 33779.02 |
| Total Medicare Standardized Payment Amount | 32466.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 55 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 2274 |
| Total Drug Medicare AllowedAmount | 1610.05 |
| Total Drug Medicare PaymentAmount | 1577.42 |
| Total Drug Medicare Standardized Payment Amount | 1577.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 674 |
| Number Of Medicare Beneficiaries With Medical Services | 164 |
| Total Medical Submitted Charge Amount | 102899 |
| Total Medical Medicare Allowed Amount | 45425.12 |
| Total Medical Medicare Payment Amount | 32201.6 |
| Total Medical Medicare Standardized Payment Amount | 30889.06 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 90 |
| Number Of Beneficiaries Age 75 to 84 | 39 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 116 |
| Number Of Male Beneficiaries | 48 |
| Number Of Non Hispanic White Beneficiaries | 67 |
| Number Of Black or African American Beneficiaries | 77 |
| 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 | 133 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2663 |