| National Provider Identifier [NPI]: | 1972537041 |
| Last Name Of The Provider | LEWIS |
| First Name Of The Provider | WILLIE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 128 POINDEXTER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 392033048 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 1449 |
| Number Of Medicare Beneficiaries | 636 |
| Total Submitted Charge Amount | 173523.93 |
| Total Medicare Allowed Amount | 103762.84 |
| Total Medicare Payment Amount | 75787.06 |
| Total Medicare Standardized Payment Amount | 84635.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 108 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 146.3 |
| Total Drug Medicare AllowedAmount | 115.76 |
| Total Drug Medicare PaymentAmount | 90.75 |
| Total Drug Medicare Standardized Payment Amount | 90.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 1341 |
| Number Of Medicare Beneficiaries With Medical Services | 636 |
| Total Medical Submitted Charge Amount | 173377.63 |
| Total Medical Medicare Allowed Amount | 103647.08 |
| Total Medical Medicare Payment Amount | 75696.31 |
| Total Medical Medicare Standardized Payment Amount | 84544.31 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 197 |
| Number Of Beneficiaries Age 65 to 74 | 219 |
| Number Of Beneficiaries Age 75 to 84 | 127 |
| Number Of Beneficiaries Age Greater 84 | 93 |
| Number Of Female Beneficiaries | 415 |
| Number Of Male Beneficiaries | 221 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 516 |
| 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 | 224 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 412 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 63 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7967 |