| National Provider Identifier [NPI]: | 1104849090 |
| Last Name Of The Provider | CHICK |
| First Name Of The Provider | WILSON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11370 ANDERSON ST |
| Street Address 2 Of The Provider | STE 2960 |
| City Of The Provider | LOMA LINDA |
| Zip Code Of The Provider | 923543450 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 4105 |
| Number Of Medicare Beneficiaries | 1094 |
| Total Submitted Charge Amount | 515838 |
| Total Medicare Allowed Amount | 130397.24 |
| Total Medicare Payment Amount | 101238.25 |
| Total Medicare Standardized Payment Amount | 71616.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 4105 |
| Number Of Medicare Beneficiaries With Medical Services | 1094 |
| Total Medical Submitted Charge Amount | 515838 |
| Total Medical Medicare Allowed Amount | 130397.24 |
| Total Medical Medicare Payment Amount | 101238.25 |
| Total Medical Medicare Standardized Payment Amount | 71616.29 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 73 |
| Number Of Beneficiaries Age 65 to 74 | 375 |
| Number Of Beneficiaries Age 75 to 84 | 414 |
| Number Of Beneficiaries Age Greater 84 | 232 |
| Number Of Female Beneficiaries | 561 |
| Number Of Male Beneficiaries | 533 |
| Number Of Non Hispanic White Beneficiaries | 32 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | 905 |
| Number Of Hispanic Beneficiaries | 131 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 120 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 974 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 31 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.8928 |